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Table 1 Summary of topical biomaterials to prevent PTH

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 N [31, 34, 35] Y [36] N [31, 34, 35], 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]. Y [59, 65]
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 Y [61], [67] 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] Floseal™ Hemostatic Matrix Post-op [61, 71] simple, safe, and efficacious and cost-effective [61, 70] 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] Clinical study on patients underwent tonsillectomy [78, 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 Y [83, 84] N [83, 84] 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