Abstract Number: LPB0069
Meeting: ISTH 2021 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Management of Bleeding and Trauma
Background: Upper gastrointestinal bleeding (UGIB) is a serious complication of bleeding disorders. Currently, clip placement and BICAP cautery are used to manage these bleeds but are technically challenging procedures to perform during active bleeding. New endoscopic hemostatic sprays that coat the bleed site and act as mechanical bandages have rebleeding rates up to 30% and display poor efficacy against severe cases of UGIB. A novel hemostatic powder has been developed that effectively propels thrombin (“propelled thrombin powder”) against blood flow and increases its delivery into sites of injury.
Aims: To test the efficacy and safety of propelled thrombin hemostatic powder for achieving lasting hemostasis in heparinized porcine models.
Methods: Five anesthetized and heparinized pigs underwent an endoscopic mucosal snare resection of the stomach wall to trigger an ulcer bleed. Propelled thrombin powder was sprayed using compressed carbon dioxide through a 7 FR catheter, inserted through the instrument channel of the gastroscope. The time to initial hemostasis from the initial application of propelled thrombin powder and the amount of powder delivered were measured. Pigs underwent a rescope 72 hours post-procedure and gross necropsy and histopathology were performed.
Results: All pigs achieved initial hemostasis in 5.4 +/- 1.2 min (n=5) with less than 5 g of powder applied. At 72 hours post-procedure, rescope showed no rebleeding in any animals. There were no signs of foreign bodies or thromboembolism during an extensive gross necropsy and histopathology of all organs examined. There was no tissue damage due to propelled thrombin powder identified around the ulcer site and coagulation parameters were comparable to baseline.
Conclusions: Propelled thrombin powder successfully stopped bleeding and prevented rebleeding in five ulcer bleeds. Propelled thrombin may be a valuable tool for rapidly halting UGIB in patients with bleeding disorders in the future. Further studies comparing efficacy to other modalities are required.
To cite this abstract in AMA style:
Ali-Mohamad N, Cau M, Baylis J, Donnellan F, Kastrup C. Self-Propelled Hemostatic Powder Safely Achieves and Maintains Hemostasis in a Live Porcine Model of Upper Gastrointestinal Bleeding [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/self-propelled-hemostatic-powder-safely-achieves-and-maintains-hemostasis-in-a-live-porcine-model-of-upper-gastrointestinal-bleeding/. Accessed March 22, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/self-propelled-hemostatic-powder-safely-achieves-and-maintains-hemostasis-in-a-live-porcine-model-of-upper-gastrointestinal-bleeding/