Impact Of Hemostatic Polyethylene-gylcol-coated Collagen Patch In Patients On Acetylsalicylic Acid Undergoing Minimally Invasive Surgery
Serdar Gunaydin, Erdal Simsek, Okay Guven Karaca, Seyhan Babaroglu.
University of Health Sciences, Ankara, Turkey.
BACKGROUND: Prolonged bleeding during minimally invasive surgery on patients with impaired coagulation is usually difficult to manage, presents a risk for the patient and increases the time and cost of surgery. Polyethylene glycol-coated collagen patch (PEG) (Hemopatch, Baxter, UK) is a recently developed hemostatic agent consisting of a specifically formulated collagen matrix, a protein-reactive monomer and a biocompatible dye. This study evaluated the efficacy and safety of the sealing hemostatic patch compared with standard hemostatic fleece in patients on acetylsalicylic acid (ASA) undergoing minimally invasive aortic surgery (mAVS).
METHODS: During a one-year period, 15 patients on ASA undergoing mAVS treated with PEG collagen patch were compared with the patients operated with standard of care (SOC: dry or wet gauze compression or similar) (N=15). The primary end point was the cessation of moderate, non-pulsating bleeds from the suture line of the aortic incision and/or dacron graft within 3 minutes of applying the hemostatic agent or SOC. Secondary endpoints included post-surgical blood loss, the number of units of autologous blood products transfused, surgical revision rates due to bleeding and cost efficiency.
RESULTS: Baseline characteristics were similar in both groups. Bleeding occurred mainly from the aorta (70%), right ventricle (17%) or right atrium (10%), more often from a vessel (87%) than tissue (37%), and was assessed to be arterial in 83% of cases. Successful hemostasis within three minutes in the study group was signifcantly better than control (80% vs 54%, p=0.032). Postoperative bleeding and transfusion of blood/blood products were significantly lower in the study group. Perioperarive data is summarized in Table. CONCLUSIONS: On the basis of our limited experience, we conclude that PEG collagen patch provides sufficient hemostasis and wound sealing in mAVS. The soft, thin, pliable, high liquid-absorption capacity, self-adherence, and sealing properties make it easy to use in minimally invasive surgery prone to bleeding. Further studies with larger patient population are warranted.
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