Surgery
and act as mechanical barriers, providing a matrix for clotting, triggering coagulation, and/or sealing adjacent surfaces. Compared to primary methods of haemostasis alone, adjunctive haemostats have been associated with reduced use of hospital resources in the following ways:11-18 l Up to 35% fewer patients require blood transfusions.
l Up to 4 days shorter length of hospital stay. l Up to 25 minutes reduced operating time. l Significantly reduces the likelihood of hospital readmission.
Furthermore, a cost analysis found that using haemostatic agents in surgeries saved approximately $19,472 per patient by reducing bleeding and the need for transfusions.19
the limitations to the current agents available and how this often leads medical professionals to use a combination of various haemostats to address disruptive bleeding. These limitations include: l Insufficient adhesive strength, which is of particular concern for bleeding at anastomotic sites involving synthetic grafts.
l Insufficient mechanical strength with liquid fibrin sealants.
l Lack of efficacy in a wet field, especially when there is arterial (pulsatile) bleeding.
l Compromised efficacy in patients with coagulation complications, for example, concomitant use of anticoagulants, antiplatelet agents, chemotherapeutics, or haemophilia.21
Despite
this, there is a lack of practical guidance for classifying surgical bleeding and characterising optimal haemostat usage.19
are working hard to address this. When seeking a systematic approach to
surgical haemostat use, J&J MedTech Surgery initiated a quantitative study to clarify the optimal use of adjunctive haemostats across 11 surgical specialties, 450 surgeons, and 7,800 bleeding occasions.5
Findings revealed that surgeons’
decisions for haemostat selection were based on surgical bleeding sites and surrounding critical anatomic structures.5
Leveraging these insights,
the evidence-based Haemostasis Optimisation Programme (HOP) was created to standardise surgical bleeding management,5 efficiency and outcomes.20
enhancing For example, the HOP
research indicates that ‘site’ and ‘situation’ are the two most important considerations for surgeons when choosing a haemostat (Fig.1).5
How current haemostatic agents can be improved With nearly 50 years of experience in this industry, we have become extremely aware of
The future of haemostatic management In response to these limitations, we’ve seen a growing trend in the production of ‘smart’ haemostatic materials, especially materials that can mimic the natural haemostatic processes of the body. These include clever mechanisms that can overcome some classical problems: l Dual action haemostats can combine antimicrobials or growth factors to promote healing or for locoregional delivery of chemotherapeutics.
l Haemostatic agents designed to manage fluid leaks – for example, bile, pancreatic secretions, serosal fluids, etc. – that occur
However, innovators
l Unsuitability for deep, irregular wounds with significant blood flow. Many available haemostatic materials are designed for irregular wounds, such as flowable gelatins and liquid fibrin sealants, but become limited in cases where there is significant bleeding.
l Use in minimal invasive surgery is limited and not optimal, especially when delivering to bleeding sites with restricted access. l Efficacy in contaminated fields.
simultaneously with bleeding or post bleeding.
l Combined use of agents to improve the visualisation of bleeding.
It is almost certain that the surgical solutions community will carry on this trend, and once established, clinicians can take comfort in emerging technologies that will enable smoother procedures and alleviate potentially significant costs. For instance, ETHIZIA (J&J MedTech) combines a porcine gelatine matrix with an embedded active polyoxazoline polymer system to improve haemostasis and is equally active and efficacious on both sides. ETHIZIA Haemostatic Sealing Patch can be stuffed, rolled, pulled apart and trimmed22-26
* Figure 1: Surgeons choose haemostats predominantly by site and situations.
- addressing several unmet needs that were voiced by the surgical community and helped in forming part of the product’s initial design strategy. This highlights the benefits of innovators maintaining close collaboration with clinicians and surgical teams to ensure they are providing dynamic haemostatic agents designed to be adopted into various settings. However, it is important to recognise that although many of the latest haemostatic agents provide surgical teams with the ideal solution, these options may not be readily accessible due to a lack of awareness or the higher cost of optimal solutions. This highlights the need for innovators to prioritise accessibility, an increasingly prominent issue within the medical community. Overall, while haemorrhaging is still a concern for the millions of surgeries performed each year, it’s important to celebrate the progress made across clinical practice, while also acknowledging the room for innovation and
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