The hemostatic efficacy of chitosan-pads in hemodialysis patients with significant bleeding tendency.
Misgav M., Lubetszki A., Brutman-Barazani T., Martinowitz U., Kenet G.
Institute of Thrombosis and National Hemophilia Center, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv – Israel.
J Vasc Access. 2017 May 15;18(3):220-224. doi: 10.5301/jva.5000707. Epub 2017 Apr 28.
Patients on chronic hemodialysis often have acquired coagulopathy that can aggravate bleeding from puncture site after needle extraction. Chitosan-based pads have been reported to accelerate hemostasis even in the presence of coagulopathy. The aim of this study was to evaluate the hemostatic efficacy of the chitosan pads compared to gauze pads, applied for local hemostasis.
A crossover study in a cohort of patients on hemodialysis with extended time to hemostasis after needle extraction. At the end of each dialysis, either gauze or chitosan pad was applied on both access points (arterial and venous). The type of pad was changed in the next dialysis all together 5 times in each patient (10 applications per patient for every pad).
A total of 288 applications, 144 for each type of pad, were performed in 15 patients. The average time to hemostasis for the entire group was significantly shorter with the chitosan pads compared to the regular gauze pads.
- A total of 288 applications (144 for each dressing type) were performed in 15 hemodialysis patients. (11 fistula, 4 graft)
- Patients included had tendency to prolong bleeding ≥ 10 minutes
- Hemostasis was achieved within 2 minutes in 78.4% after the first application.
- The success rate was increased to 98.6% with a second 4-minute application and in only two occasions a third application was needed to stop the bleeding.
- There was no single case of late out-of-hospital bleed.
- The average time to hemostasis for the entire group was significantly shorter with the chitosan dressing compared to the pad gauze (“arterial” point 3 vs. 18.5 min, p<0.001 “venous” access 2.8 vs. 13.2 min, p<0.001, respectively).
- Use of HemCon dressing saved patient time from roughly 30-60 minutes per visit
Chitosan pads significantly reduce time to hemostasis and should be considered for the treatment of accessible bleeds in patients with coagulopathy.
“Local hemostasis is significantly more effective with chitosan-pad it is possible that the reduction in pressure time can positively impact the longevity of the fistula with by itself would have a significant added value”
For more information see link: https://www.ncbi.nlm.nih.gov/pubmed/28478622