From: Topical biomaterials to prevent post-tonsillectomy hemorrhage
Biomaterial | Decrease PTH severity (Y/N) | Decrease PTH incidence (Y/N) | Reduce pain (Y/N) | Study type | Commercial Products | Administer type | Other outcomes | FDA approval for human (Y/N) | |
---|---|---|---|---|---|---|---|---|---|
Fibrin-based Hemostasis glue/fleece/ patch/ | Fibrin glue: Fibrinogen and/or thrombin | Y [36] | Y (spray) [38] | randomized double-blind study on 50 adults patients [34], prospective randomized double-blind study on 168 consecutive patients and systematic review [31] | Tissucol™/ Tisseel™, and Crosseal™ / Quixil®, Evicel® | Post-op | Easy to use, maybe time efficient in operation but storage at low temperatures, and long thawing time [31]. decreased immediate inflammatory response following adenotonsillectomy [37]. Not enough sample sizes were studied [31]. | ||
Fibrin-based collagen fleece/patch | reduced emergency surgery for severe PTH without an apparent adverse effect [66] | N [66] | Y [66] | Clinical study on 1057 children patients [66] | TachoComb®, TachoSil®, Evarrest® fibrin sealant patch | Post-op | provided a mechanical scaffold on which vascular regeneration occurred. Not cost efficient. Too expansive for some surgical units [58] | Y TachoSil [48] Y Evarrest® [54] N TachoComb | |
Gelatin-based Hemostat | Gelatin-Thrombin Hemostatic Matrix (GTHM) | Y [67] N | N [68] | Case study by reviewing 42 pediatric patients and retrospective data analysis [61], randomized, controlled trial in adults [68, 69] and children [67, 70] and a review [71] | Flosealâ„¢ Hemostatic Matrix | Y [72] | |||
Absorbable cellulose-based Hemostat | oxidized cellulose polymer hemostatic agent | Y [73] | Y (when combine with suturation) [74] | N (when combine with suturation) [74] | Surgicel plus saturation on total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years [74] | Surgicel®, Cellistypt®, Pahacel®, Oxycel®, Gelita®, GuraTamp® | Intra-op | aids in clot formation by activation of the extrinsic and intrinsic coagulation pathways, Introduced a risk of aspiration and suffocation [75]; Possible inflammation [76]. | Y Surgicel® [77] N for others |
Bismuth subgallate-based | BSG- adrenaline paste, BSG- phenylephrine hydrochloride mixture | Y [78] | Y (BSG mixed with phenylephrine hydrochloride) [79] Y BSG with adrenaline for primary PTH [80], N for secondary PTH [81] | N [81] | Spectrum Chemical (powder), mixing 26 g of BSG powder to 20 ml of normal saline with 0.7 ml of 1:1000 adrenaline | Post-op | decreases operating time by significantly reducing the hemostasis time and the number of ligatures [78, 81]; accelerates the cascade of blood clotting [79]; accelerate the intrinsic clotting pathway through the activation of factor XII (Hageman factor) [82]. | Y [62] | |
Antifibrinolytics | tranexamic acid (TXA) liquid | – | Clinical reports analysis of 246 patients topically treated with TA and 248 control [84] Systematic review [83] | Cyklokapron® | Postop | no device or site for infection, reduce intraoperative blood loss during Orthognathic Surgery, prevent postop hemorrhage after oral or dental surgery in hemophilia A patients and those on warfarin anticoagulation [85] | N for Topical application | ||
Natural material | Propolis | – | Y [86] | Y [86] | Randomized controlled study on 65 patients [86] | Topical propolis gel | gargle immediately after surgery [86] | accelerated wound healing of tonsillar fossae | N |
Herbal ingredients | Y [87] | – | – | Clinical trial in 47 consecutive children patients | Ankaferd Blood Stopper® | Intra-op | safe and efficient, and it reduces operating time [87], and contains no synthetic additives [88] | N | |
Autologous serum | – | Y [89] | Y [89] | A preliminary study on 32 patients (4–15 years old) [89] | Centrifuge peripheral venous blood at 1500–2000 g for 10 min to separate the serum and then topically administered | Intra and post 8 and 24 h | Contributed to tonsillar fossa epithelization in postoperative period Only preliminary study was performed | N |