Evaluation of the efficacy of modern endoscopic powdered hemostatic agents using piezoelectric thromboelastography: a pilot experimental non-randomized study

INTRODUCTION: The treatment of gastrointestinal bleeding and the choice of method of endoscopic hemostasis remain urgent issues in surgery. Application of insufflation endohemostasis methods with use of powdered hemostatic systems is currently a promising approach in therapeutic endoscopy.

AIM: To conduct a comparative analysis of the effect of powdered hemostatic agents EndoClot®, Aseptisorb® and alginate polymer polysaccharide hemostatic hydrogel (APPHH) on the dynamics of parameters of the blood aggregate condition regulation system using piezoelectric thromboelastography method.

METHODS: The object of the study was citrated venous blood from 14 healthy male volunteers aged 20 to 30 years, with mean age (23.70±2.86) years. With each blood sample, several analyses were conducted: without the test material (control group) and with the addition of EndoClot® (group 2), Aseptisorb® (group 3) and APPHH (group 4). The effect on the aggregate condition of blood in vitro was evaluated by thromboelastography (АRP-01М Mednord piezoelectric thromboelastograph (Mednord-Tekhnika, Russia)). The following chronometric parameters were analyzed: time of the contact phase of coagulation, time to reach thrombin constant, blood clotting time, clot polymerization time, fibrin-platelet clot formation time, fibrinolysis onset time, and also qualitative parameters: intensity of the contact phase of coagulation, thrombin activity constant, coagulation drive intensity, clot polymerization intensity and maximal clot density.

RESULTS: It was found that the studied samples are not effective in the initial clot formation process (platelet adhesion and aggregation), they realize the main hemostatic effect through the influence on coagulation processes: EndoClot® reduces blood clotting time from 9.90 (8.90–11.30) minutes to 7.25 (5.50–7.80) minutes (p <0.0001), Aseptisorb® — to 5.40 (3.40–7.50) minutes (p <0.0001), and APPHH — to 3.20 (2.40–3.90) minutes (p <0.0001). However, EndoClot® does not affect the first stage of the coagulation cascade — the process of reaching the thrombin constant, which reduces its hemostatic activity. Hemostatic agents Aseptisorb® and APPHH initiate hemostatic activity at the stage of reaching the thrombin constant and then increase it at the stages of clot polymerization.

CONCLUSION: Powdered hemostatic agents EndoClot®, Aseptisorb® and APPHH possess pronounced hemostatic activity affecting coagulation processes. The domestic hemostatic agents Aseptisorb® and APPHH demonstrated the best hemostatic properties a significant effect has been recorded already at the initial stages of the coagulation cascade with subsequent increase in the hemostatic activity and reduction of blood coagulation time.