Department of Surgery (M.W.C., N.V., J.C.W., P.E.G.), UT Southwestern, Dallas, Texas; UT Houston Health Science Center (C.C.C.), Houston, Texas; and Department of Clinical Sciences, Division of Biostatistics (P.A.N.), UT Southwestern, Dallas, Texas.
J Trauma Acute Care Surg. 2018 Sep;85(3):485-490. doi: 10.1097/TA.0000000000001999.
The use of kaolin-coated dressings has become common and have efficacy in normal patients, but their increased use will inevitably include use on bleeding patients taking anticoagulants. We hypothesize that kaolin coating material (KCM) will improve clotting regardless of anticoagulation medication.
A prospective study was performed on blood from patients who were on a vitamin K antagonist (VKA), unfractionated heparin (UH), an antiplatelet (AP) agent, a Xa inhibitor (Xa), or a direct thrombin inhibitor (DTI). None were on more than one type of anticoagulation medication. Viscoelastic testing was performed with and without KCM. All p values were adjusted for multiple comparisons.
The addition of KCM significantly decreased the time for initial clot formation (CT) in all groups. The mean CT for controls was decreased from 692 to 190.8 s (p < 0.0001). KCM decreased the initial clot formation time by about 1.5 times in those on DTI (p = 0.043) and 2.5 times in those taking AP medication (p < 0.001). The most profound effect was seen in those on UH (no KCM 1,602 s vs. KCM 440 s; p < 0.001), VKA (no KCM 1,152 s vs. 232 s; p < 0.01), and Xa (no KCM 1,342 s vs. 287 s; p < 0.001). Analysis of other clot formation parameters revealed that KCM significantly improved the clot formation kinetics (CFT) only in patients taking Xa (p = 0.03). KCM improved maximum clot strength in patients on Xa inhibitors (p = 0.05). Patients on UH had a larger effect size with an increase in clot strength from 24.35 mm to 43.35 mm whereas those on Xa had an increase of 38.7 mm to 49.85 mm.
In this in vitro analysis, the addition of KCM to the blood of patients taking any of these anticoagulation medications significantly improved the time to initial clot formation, indicating that kaolin-based hemostatic dressings will be effective in initiating clot formation in patients on anticoagulants.
Therapeutic, level IV.
高岭土涂层敷料的使用已变得普遍，对普通患者有效，但随着其使用的增加，不可避免地包括对正在服用抗凝剂的出血患者的使用。我们假设高岭土涂层材料（KCM）将改善凝血，无论是否使用抗凝药物。
对正在服用维生素 K 拮抗剂（VKA）、未分级肝素（UH）、抗血小板药物（AP）、Xa 抑制剂（Xa）或直接凝血酶抑制剂（DTI）的患者的血液进行前瞻性研究。患者均未同时使用两种以上抗凝药物。进行了有和没有 KCM 的黏弹性测试。所有 p 值均经多次比较调整。
在所有组中，添加 KCM 均显著缩短初始凝块形成时间（CT）。对照组的平均 CT 从 692 秒降至 190.8 秒（p<0.0001）。在服用 DTI 的患者中，KCM 将初始凝块形成时间缩短了约 1.5 倍（p=0.043），在服用 AP 药物的患者中缩短了 2.5 倍（p<0.001）。在接受 UH（无 KCM 1,602 秒对 KCM 440 秒；p<0.001）、VKA（无 KCM 1,152 秒对 KCM 232 秒；p<0.01）和 Xa（无 KCM 1,342 秒对 KCM 287 秒；p<0.001）治疗的患者中，效果最为显著。对其他凝块形成参数的分析表明，KCM 仅显著改善了服用 Xa 的患者的凝块形成动力学（CFT）（p=0.03）。KCM 增加了服用 Xa 抑制剂患者的最大凝块强度（p=0.05）。与 Xa 抑制剂相比，接受 UH 治疗的患者的凝块强度变化幅度更大，从 24.35 毫米增加到 43.35 毫米，而 Xa 的患者从 38.7 毫米增加到 49.85 毫米。
在这项体外分析中，在接受这些抗凝药物治疗的患者的血液中添加 KCM 可显著缩短初始凝块形成时间，表明基于高岭土的止血敷料将有效启动抗凝患者的凝块形成。
治疗，IV 级。
