Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Endoscopy. 2015 Jul;47(7):638-45. doi: 10.1055/s-0034-1391353. Epub 2015 Jan 15.
Hemospray (Cook Medical Inc., Winston-Salem, North Carolina, USA) is a novel, hemostatic, powder spray that has been developed for gastrointestinal use. The powder is thought to achieve hemostasis by concentrating clotting factors and forming a mechanical plug on the injured blood vessel. However, no detailed studies on the hemostatic mode of action have been performed. The aim of this study was to examine the effects of Hemospray on coagulation and clot formation both in vitro and in vivo.
Recalcification time, thromboelastometry using EXTEM and INTEM assays, and plasma coagulation tests (activated partial thromboplastin time and prothrombin time) were carried out on blood samples mixed with Hemospray, and compared with talcum powder (negative control) and kaolin (positive control) at 1 mg/mL and 10 mg/mL. Scanning electron microscopy (SEM) and light microscopy were performed on in vitro thrombi and on gastric thrombi from an animal model of gastrointestinal hemorrhage treated with Hemospray.
The median recalcification time of whole blood was 187.5 seconds. The addition of 1 mg/mL and 10 mg/mL Hemospray significantly shortened this time (median 60 and 45 seconds, respectively; P < 0.05). The median clotting time of whole blood, measured using the INTEM assay, was 160 seconds (interquartile range [IQR] 159 - 176.5) and this was also significantly reduced by the addition of Hemospray (91 seconds [IQR 84 - 102]; P = 0.005). The plasma prothrombin time of 11.6 seconds was significantly reduced by Hemospray (9.5 seconds; P = 0.011). SEM of in vivo clots demonstrated that Hemospray rapidly interacted with whole blood, forming one confluent mass over the bleeding site. In sufficient amounts, Hemospray was able to deform and pack erythrocytes.
Hemospray covered the bleeding site and enhanced clot formation in vivo, and shortened coagulation time in vitro. Elaboration of these unique properties in clinical practice will help to optimize future endoscopic hemostasis with Hemospray.
Hemospray（美国北卡罗来纳州温斯顿-塞勒姆的库克医疗公司）是一种新型的止血粉末喷雾，专为胃肠道使用而开发。该粉末通过集中凝血因子并在受伤的血管上形成机械塞来达到止血的效果。然而，尚未对其止血作用模式进行详细研究。本研究旨在检查 Hemospray 对体外和体内凝血和血栓形成的影响。
在 1mg/mL 和 10mg/mL 时，将血液样本与 Hemospray 混合，并与滑石粉（阴性对照）和高岭土（阳性对照）进行再钙化时间、EXTEM 和 INTEM 测定的血栓弹性描记术以及血浆凝血试验（活化部分凝血活酶时间和凝血酶原时间）比较。对体外血栓和用 Hemospray 治疗胃肠道出血动物模型的胃血栓进行扫描电子显微镜（SEM）和光学显微镜检查。
全血的中位再钙化时间为 187.5 秒。添加 1mg/mL 和 10mg/mL 的 Hemospray 可显著缩短该时间（中位数分别为 60 和 45 秒；P<0.05）。使用 INTEM 测定测量的全血凝血时间中位数为 160 秒（四分位距 [IQR] 159-176.5），添加 Hemospray 也显著缩短了凝血时间（91 秒 [IQR 84-102]；P=0.005）。Hemospray 使 11.6 秒的血浆凝血酶原时间显著缩短（9.5 秒；P=0.011）。体内血栓的 SEM 显示 Hemospray 迅速与全血相互作用，在出血部位形成一个连续的块状物。在足够的量下，Hemospray 能够变形并包裹红细胞。
Hemospray 覆盖出血部位并促进体内血栓形成，并缩短体外凝血时间。在临床实践中详细阐述这些独特的特性将有助于优化未来使用 Hemospray 的内镜止血。
