Self-propelling hemostatic powder safely achieves and maintains hemostasis in a live porcine model of upper gastrointestinal bleeding by Nabil Ali Mohammed, Massimo Kao, James Bayliss, Andrew McFadden, Christian Kastrup, and Fergal Donilon. Hemostatic powders have recently become an attractive option in managing upper gastrointestinal bleeding for their ease of use and their ability to cover large surface areas. However, currently available powders are associated with unacceptably high re-bleeding rates. These limitations are related to their mechanism of action acting as a mechanical bandage on the site of injury. A novel hemostatic powder that self-propels and delivers thrombin against the flow of blood, also known as propelled thrombin, has been developed. Previously, propelled thrombin was used to stop bleeding in 12 bleeds in 5 pigs of severe upper gastrointestinal bleeding. In this case, we aim to assess whether propelled thrombin prevents re-bleeding and is safe within 72 hours in an ulcer-bleeding model in 5 pigs. The bleed and ulcer was made using a standard endoscopic snare with mucosa removed until a steady flow of blood was obtained. Up to 5 grams of propelled thrombin powder was applied to the ulcer site and closely monitored for hemostasis. Once hemostasis was achieved, the ulcer was observed for an additional 10 minutes to ensure a stable clot. At 72 hours after the procedure, the pigs were scoped once again to observe the ulcer site for any signs of re-bleeding. Here in pig 1, no active bleeding was identified. The small specks on this ulcer were later determined to be food particles in histology. In pig 2, an identical course of action was taken, and here only the application of propelled thrombin is shown. Once again, 72 hours after the procedure, pig 2 was also scoped to observe the ulcer site for any signs of rebleeding, and none were identified. Finally, we take you to pig number 4, where the exact same procedure was followed, and propelled thrombin powder was applied. Once again, at 72 hours, no signs of rebleeding were identified in this pig. Rebleeding was not observed throughout the 72-hour recovery period in all 5 pigs where this procedure was performed. ACT, APTT, red blood cell, platelet count, fibrinogen, and d-dimer levels were all unchanged at the 72-hour mark compared to baseline. Gross necropsies and histopathology of heart, brain, liver, lungs, kidneys, pancreas, and adjacent lymph nodes showed no evidence of thromboembolism. Histopathology of ulcer sites showed signs of healing at 72 hours with healthy fibroblast proliferation. In conclusion, here we showed that propelled thrombin can safely stop upper gastrointestinal bleeding and prevents rebleeding within 72 hours. Further studies comparing efficacy of propelled thrombin to current standards of care are required.

Self-propelling hemostatic powder

upper gastrointestinal bleeding

propelled thrombin

hemostasis

rebleeding prevention