Academic literature on the topic 'Hemostatic pack'

ABSTRACT Aim The aim of this study was to evaluate the efficacy of Axiostat Hemostatic Dental dressing in achieving hemostasis postextraction and determining its effect on pain and healing of the extraction wound, compared with control, i.e., conventional method of extraction in patients on oral antiplatelet therapy. Materials and methods Totally, 40 patients on oral antiplatelet drugs were included in the study and overall 80 extractions were done applying split mouth study design, without altering patient's drug regime. Extraction sites were divided into two groups: Group I received Axiostat Hemostatic Dental Dressing (study site), and group II received conventional method; pressure pack with sterile gauze under biting pressure followed by suturing if required (control site) was used to attain hemostasis. Results Extraction sites treated with Axiostat Hemostatic Dressing achieved hemostasis earlier (mean 1 minute 13 seconds) compared with control sites (mean = 14 minutes 1 second), which was also statistically significant (p < 0.001). Postoperative pain was considerably lower and significantly better healing was seen in the study group (p < 0.001) compared with the control. Conclusion Axiostat demonstrated to be an effective hemostatic agent that considerably lessens the bleeding time in patients on oral antiplatelet drugs postextraction. In addition, it even offered minimal postoperative pain and improved healing of the extraction wound. On comparing the results of this study with our study on HemCon Dental Dressing, Axiostat Dental Dressing (ADD) is found to be as effective and at par in achieving hemostasis in patients on oral antiplatelet therapy. Clinical significance The past few decades have seen an upsurge in use of low-dose aspirin either alone or in combination with other drugs. When these patients require dental/maxillofacial treatment, earlier concept of stopping these medications is associated with increased risk of thromboembolic event. The present study highlights an alternative approach using ADD which aids in quick hemostasis, accentuates healing, and reduce postoperative pain. How to cite this article Sharma S, Kale TP, Balihallimath LJ, Motimath A. Evaluating Effectiveness of Axiostat Hemostatic Material in achieving Hemostasis and Healing of Extraction Wounds in Patients on Oral Antiplatelet Drugs. J Contemp Dent Pract 2017;18(9):802-806.

Background The optimal form of nasal packing after endoscopic sinus surgery (ESS) still has not been established. Although wide variations exist among sinus surgeons, the goals are adequate hemostasis, rapid healing, and patient comfort. Preliminary studies indicated that FloSeal (FS), a novel absorbable hemostatic paste used as a nasal pack, was associated with minimal postoperative discomfort and effective hemostasis. This study was designed to evaluate the effects of this agent on mucosal healing in ESS. Methods Twenty consecutive patients underwent bilateral ESS. For each patient, one ethmoid cavity was randomized to receive FS and the other received thrombin-soaked gelatin foam. The extent of granulation tissue and adhesion formation was evaluated at 6–8 weeks after surgery. Results No significant differences were observed between the FS and the thrombin-soaked gelatin foam groups with respect to the preoperative Lund-Mackay score, extent of surgery performed, or need for additional nasal packing. However, the FS group showed clear trends toward increased granulation tissue (p = 0.007) and adhesion (p = 0.006) formation. Conclusion: Absorbable hemostatic agents are associated with a high degree of patient comfort and provide hemostasis comparable with traditional techniques. Different materials may induce differential patterns of mucosal healing, potentially affecting the ultimate result of ESS.

Objectives: This pilot study compared hemostatic pack (HP) application with no intervention following extraction of maxillary primary incisors in healthy children for effect on bleeding time and influence of patient or tooth variables utilizing a novel scale for assessment of bleeding following extraction. Study Design: A novel scale was created to assess bleeding after extraction. This scale was utilized in a randomized, split mouth study of healthy children ages 2–7 years old requiring extraction of at least 2 primary maxillary incisors under general anesthesia. One extraction site was randomly assigned to receive HP and the other had no hemostatic measures. Post-operative bleeding was rated at 2, 10, and 15 minutes post-extraction. Other variables recorded included age, sex, periapical radiolucency, presence of fistula, swelling, discoloration, intraoral stabilization device used, and vital signs at two time intervals. Pre-operative radiographs were reviewed for root resorption and periapical radiolucency. Results and Conclusions: Twenty-five patients provided 50 teeth. Hemostatic pack had a significant effect on reducing bleeding at each time point and that effect did not change over time. Age, sex, tooth pain, post-extraction heart rate, blood pressure, discoloration, amount of resorption, and presence of a periapical radiolucency had no significant effect on bleeding. The proposed bleeding scale had good intra-rater reliability and could be useful in future studies, once validated.

ABSTRACT Objectives: The management of patients receiving oral anticoagulant therapy (OAT) undergoing minor oral surgeries is controversial. This study was designed to evaluate the correlation between International Normalized Ratio (INR) values and the sufficiency of two different local hemostatic measures in controlling postextraction bleeding in anticoagulated patients. Materials and Methods: One hundred and sixty patients receiving Warfarin OAT were included in this study. Patients were selected so that 80 patients have INR values of ≤2, whereas the remaining patients have the INR values ranging from 2 to 3. Forty patients were then randomly selected from each category to form two equal groups. Forty-five patients who had never been on OAT were selected as a negative control group (group 1). Failure to achieve hemostasis using a pressure pack was managed using either tranexamic acid (group 2) or Ankaferd Blood Stopper (ABS) (group 3). Results: The INR values of patients included in group 2 and 3 ranged from 1.5 to 3, with a mean of 2.2. No significant difference was recorded between the use of either tranexamic acid or ABS in achieving hemostasis in anticoagulated patients with INR values ranging between 2 and 3 (P = 0.93). Conclusion: Based on our findings, ABS is a hemostatic agent of good efficacy. The effect of ABS in controlling post-extraction bleeding in anticoagulated patients with INR values ≤3 is comparable to tranexamic acid with no evidence to support the superiority of tranexamic acid over ABS.

ABSTRACT Background In Indian clinical practice, conventional nasal packing for hemostasis after routine rhinological surgery is usually performed with Vaseline (paraffin) gauze, and rarely with glove-finger packs or tamponade balloons. These materials are tedious to pack and cause discomfort to the patient on removal. Newer nasal packs which have recently emerged in the Indian scenario are found to be more user-friendly, equally effective for hemostasis and less traumatic to the operated nasal mucosa. Most rhinologists today, prefer to use polyvinyl acetate sponge packs (Merocel/Ivalon) for tamponade after nasal surgery. These packs are very effective but non-absorbable and need to be removed which does not augur well with many patients postoperatively. The recent entry of a biodegradable synthetic polyurethane foam (Nasopore) as an alternative nasal packing material, has evoked new interest, which initiated this study. Study method This prospective randomized double-blinded controlled study was aimed to compare the clinical efficacy and patient comfort level, while using Merocel and Nasopore as packing material after functional endoscopic sinus surgery (FESS). This study included thirty adults who were diagnosed with moderate to severe bilaterally comparable chronic rhinosinusitis, who underwent FESS under general anesthesia and received size-matched nasal packs randomly - Merocel on one side and Nasopore on the other. The assessment of clinical efficacy of both packs with regards to ease of packing, hemostasis, pressure effects, infections and adhesions was done with a Diagnostic Nasal Endoscopy at first postoperative day, first week and fourth week after surgery. All Merocel packs were removed on the first postoperative day. Patient comfort levels for both packs were recorded with a standard symptom questionnaire marked on a visual analogue scale of ten and the results were statistically compared between the two groups. Results Comparable outcomes were found while using Merocel or Nasopore with regards to ease of nasal packing and control of postoperative bleeding. There was a statistical difference in the hemostatic property between the two materials in the immediate postoperative period. Five out of 30 patients developed reactionary bleeds with Nasopore, which required repacking with same material within the first 24 hours, but no further bleeds were noted. Two out of these five patients on the first postoperative day had migration of Nasopore toward the choana and had to be repacked with additional Nasopore. Sequential postoperative nasal endoscopy revealed that Nasopore is more mucosal friendly with lesser incidence of adhesions, synechiae, infection and edema, with better biocompatibility and safety. The major success with Nasopore was found to be, the fact that no pack removal was necessary, which immensely improved patient satisfaction and willingness to use the material when compared to Merocel. This was proved by the patient's symptom questionnaire which showed significant benefits of Nasopore over Merocel with regards to compliance and comfort levels. Conclusion Nasopore is a novel biodegradable synthetic material which is clinically as efficacious and patient-friendly as Merocel and is suitable for postoperative nasal packing after functional endoscopic sinus surgery. The clinical benefits of Nasopore and its outcomes among patients as recorded in our study, stands proof to support Nasopore as a successful packing material in rhinological surgery. How to cite this article Raghunandhan S, Kameswaran M, Thomas JK. A Prospective Double-Blinded Randomized Controlled Study Comparing the Efficacy of a Novel Biodegradable Synthetic Polyurethane Foam (Nasopore) vs Standard Polyvinyl Acetate Sponge (Merocel) as Packing Material after Functional Endoscopic Sinus Surgery: The First Indian Experience. Clin Rhinol An Int J 2014;7(3):105-111.

Background: Acetylsalicylic acid (ASA) generically known as Aspirin is an analgesic, antipyretic, anti-inflammatory and also an antiplatelet drug. In order to avoid excessive bleeding and to be on the safer side, dentists have traditionally advised their patients to stop taking aspirin before extraction of teeth although this surgical procedure can be done without cessation of aspirin intake. Objective: The purpose of the study was to assess the necessity of interrupting aspirin therapy prior to dental extraction. Materials and Methods: A cross sectional study was conducted in November 2015 at outpatient department of dentistry, BIRDEM Hospital, Dhaka. Sample of 50 patients who took low dose aspirin (75mg) once daily were purposely selected for this study. The blood pressure of all the subjects was recorded preoperatively. The extractions were done atraumatically under local anesthesia using 2% lidocaine with 1:100,000 epinephrine. A gelatin sponge piece was placed in socket and closed by atraumatic silk. The subjects were instructed to apply pressure pack with sterile gauze for 30 min. Evaluation was done in every 10 minutes for 30 minutes. Results: Among 50 patients, 82.0% patients were suffering from IHD. Simple extraction was done in 92.0% of patients while the remaining extractions were done surgically. 68% was managed by pressure pack and gelatin sponge while 26.0% were managed by pressure pack only. According to Post-extraction bleeding, it was found that the bleeding time was 10 min in case of 94% patients while only 2% showed 30 minutes of bleeding time. Conclusion: The study revealed that it is not necessary to alter or stop aspirin therapy and local hemostatic measures are sufficient to control bleeding. Therefore it can be assumed that extraction can be done without cessation of low dose aspirin and avoiding the life threatening issues. Update Dent. Coll. j: 2019; 9 (1): 32-36

INTRODUCTION In this research we study the effect of Nasal decongestant Xylometazoline 0.1% solution on Serial measurements of Nasal peak flow rates in a cohort of patients who were suffering from Acute Sinusitis. CASE SERIES A population of 90 patients were chosen from our regular Out-patient clinics who were suffering from Acute Sinusitis based on a Clinical diagnostic criterion. A baseline Nasal peak Flowmetry was done before and this was followed by common Decongestant Xylometazoline 0.1% solution spray application, followed by serial readings of Nasal peak Flowmetry done after 10 minutes, 25 minutes, 60 minutes, 120 minutes,240 minutes and 360 was taken then plotted and analysed. DISCUSSION From the A.U.C Curves it can be inferred that Maximum decongestant action of Xylometazoline 0.1% solution is seen 1 hour after application and the raise in decongestant reaches a plateau by 2 hours. Readings remain elevated from baseline well 6 hours post decongestion. CONCLUSION Patients who are prescribed Xylometazoline 0.1% solution are advised that maximum relief from congestion would be obtained around 1 to 2 hours after application and hence effect would decrease. Surgeons who use Xylometazoline 0.1% solution for nasal packing must proceed with the Surgery within 1 hour of application of the pack to obtain maximum hemostatic and decongestant benefit of this drug.

Introduction: Acute trauma coagulopathy (ATC) is associated with severe hemorrhage. ATC etiology is often multifactorial, with acquired fibrinogen deficiency and consumption of clotting factors recognized as major factors. The FiiRST-2 study will determine the impact of early co-administration of fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) on the total number of allogeneic blood products (ABPs) transfused compared to the current standard of care (ratio-based plasma resuscitation). Methods: FiiRST-2 is a multicenter (8 Canadian centers), pragmatic, randomized, parallel-control, superiority trial with a two-armed, two-stage design with an adaptive interim analysis. Research ethics board approval has been obtained and the study complies with the Declaration of Helsinki. Trauma patients &gt;16 years old at risk of massive hemorrhage will be randomized to receive FC + PCC or standard of care (ratio-based plasma resuscitation + FC in response to low fibrinogen levels) (Table 1) until all units in the second massive hemorrhage protocol (MHP) pack have been administered, or earlier if the MHP is terminated. The primary endpoint is to demonstrate superiority with respect to the number of ABP units (RBCs [red blood cells] + plasma + platelets) transfused within 24 hours of arrival at the trauma bay/emergency department. Secondary endpoints include RBC units transfused within 24 hours, incidence of thromboembolic events, and ventilator-free days up to Day 28. Safety endpoints include all adverse events (AEs) and serious adverse events (SAEs) up to Day 28. It is projected to enroll 360 patients depending on the results of the Interim analysis. Results: An interim analysis will be performed after 120 patients have completed the study. The study is expected to start late 2020 and enrollment is expected to require about 2 years. Conclusions: FiiRST-2 will determine if early hemostatic therapy with FC + PCC is superior to standard MHP packs in bleeding trauma patients. Results could have a major impact on clinical practice and improve management and outcomes in this high-risk group of patients. Disclosures Da Luz: Octapharma Canada: Research Funding. Callum:Octapharma: Research Funding; Canadian Blood Services: Research Funding. Schwartz:Octapharma: Current Employment. Karkouti:Canadian blood services: Research Funding; Octapharma: Research Funding. OffLabel Disclosure: PCC and fibrinogen concentrate for acquired coagulopathic bleeding (off-label in the USA)

Nasal occlusive dressings are routine after nasal surgeries to arrest hemorrhage, to prevent septal hematoma, and to prevent postoperative adhesions. However, patients describe nasal packing and its removal as their worst experience. Various types of nasal packs are available. Medicated ribbon gauge is the traditional form of nasal pack which consists of an open-mesh cotton as a carrier whereas “Polyvinyl Acetate’ sponge is a compressed dehydrated material, an improvised one which increases in size and compresses blood vessels when rehydrated with normal saline. As Polyvinyl acetate sponge is smooth and spongy, it causes less pain and abrasion while in-situ and removal. This was a prospective comparative study done in tertiary hospital of Nepal. Patients were subjected to either polyvinyl acetate sponge or ribbon gauge nasal pack following nasal surgery. Comparisons were made in terms of pain score, maintenance of hemostasis and wound healing. There were 154 patients in the study with 104 males and 50 females. The pain score when nasal pack was in-situ was similar in both groups whereas it was lesser in the polyvinyl acetate group on its removal. However, bleeding and adhesion were found to be similar. Crust formation was less in polyvinyl acetate group. Six synaechia were noted in ribbon gauge group only. Pain was significantly less during removal of polyvinyl acetate pack.