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Use of Tissue Sealants and Hemostatic Agents in Surgery Martha K. Terris, M.D. Medical College of Georgia
Hemostasis “life in the balance” CVA MI DVT PE Trauma Surgery Anticoagulation Hemophilia Bleeding to Death Clotting  to Death
 
Why Use Hemostatic Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A Century of Hemostasis Surgeons today have an impressive set of tools to manage intra-operative bleeding. But how do you know what to use? 1900  1950  2000 Clamps  Clips  Sutures  Direct Compression  Bone wax Electrocautery  Laser  Argon beam ORC  Gelatin  Thrombin Flowable gelatin Fibrin Sealants Synthetic Sealants
History of Hemostasis ,[object Object],[object Object]
Factors in Choosing a Hemostatic Agent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Materials Properties/Handling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Site Characterization ,[object Object],[object Object],[object Object],[object Object]
 
Bleed
Bleed Collagen, ORC Flowable Gelatin Thrombin Fibrin Sealant
Bleed Platelet inhibitors, NSAIDS, ASA, Clopidogrel Thrombin inhibitors, Heparin, Warfarin tPA, uPA Trauma, Time, Us!
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
INSTAT  ,[object Object],[object Object],Instat MCH (Microfibrillar Collagen Hemostat Powder)
AVITENE Avitene Collagen Sponge (Absorbable Hemostat Sponge) Avitene MCH Flour (Microfibrillar Collagen Hemostat Powder)
Collagen INSTAT (J&J) and Avitene (Davol) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Avitene Applicators ,[object Object],[object Object]
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oxidized Regenerated Cellulose (ORC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Absorbs Fluids Causes platelet plug formation
$12 $15 $20
How Does SURGICEL Work?
Why is SURGICEL Bactericidal?
SURGICEL ,[object Object],[object Object],[object Object],[object Object]
SURGICEL ,[object Object]
SURGICEL SURGICEL Mesh adherent to area of bleeding SURGICEL Nu-Knit used to make bolsters for partial nephrectomy
SURGICEL Fibrillar Can be shredded, compacted, or moistened and molded to various shapes
 
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GELFOAM/SURGIFOAM  ,[object Object],SURGIFOAM Absorbable Gelatin Powder GELFOAM Absorbable Gelatin Sponge SURGIFOAM Absorbable Gelatin Sponge
GELFOAM/SURGIFOAM ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Flowable Gelatin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Flowable Mechanism of Action ,[object Object],[object Object],[object Object]
Flowable Mechanism of Action ,[object Object],[object Object]
Flowable Gelatin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Flowable Gelatin
Flowable Gelatins Surgiflo
Endoscopic Applicator for Flowable Gelatins ,[object Object],[object Object],[object Object],[object Object]
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bleed Collagen, ORC Flowable Gelatin Thrombin Fibrin Sealant
Thrombin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thrombin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bovine Thrombin ,[object Object],[object Object]
Isolation of anti-Bovine Thrombin Antibodies 1989  90  91  92  93  94  95  96  97  98  99  00  01 Clinical Reports of Patients with Major Complications from Antibodies Prospective Analysis of Thrombin Exposure in Surgical Patients Autoimmune Processes Linked with Use of Bovine Thrombin
Pooled Human Plasma Products ,[object Object],[object Object],[object Object]
 
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
History of Fibrin Sealants ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fibrin Sealants Target the Final Steps of the Coagulation Cascade
Thrombin and Fibrinogen ,[object Object],[object Object],[object Object]
Anti-Fibrinolytics ,[object Object],[object Object],[object Object],[object Object]
Bleed Collagen, ORC Flowable Gelatin Thrombin Fibrin Sealant
US Indications by Brand ,[object Object],[object Object]
Fibrin Sealants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tisseel
Evicel
Tisseel
Fibrin Sealants ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Hemostasis and Sealing Market ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Synthetic Sealants ,[object Object],[object Object],[object Object]
BioGlue ,[object Object],[object Object],[object Object]
CoSeal ,[object Object],[object Object],[object Object],[object Object]
Cost ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ All Bleeding Stops”

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Use Of Tissue Sealants And Hemostatic Agents