There will be blood

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Jaime Landman
Associate Professor, Urology
Columbia University

March 17th, 2008, at 8:53am · 7 Comments

There is an amazing amount of hype and bad data surrounding the use of hemostatic and sealing agents. Despite thousands of manuscripts published on the various glues, pastes and potions currently being hawked, there is a major dearth of solid information.

I have sat and listened to biotech reps and fellow surgeons swear that their individual brew works all of the time, with complete sealing, no evidence of leakage, and great hemostasis.

No go, my friends. I have tried them all.

To date, I have stopped bothering with fibrin-based products and artificial glues. They are costly, and there is even data that these products can cause a nasty reactive process in the urinary tract. With the exception of Floseal, which remains a good adjunct to proper surgical technique (but certainly cannot substitute for it), I remain entirely unimpressed.

Tags: Cardiac surgery · Colorectal surgery · Drugs · General surgery · Gynecology · Hemostasis · Neurosurgery · Orthopedic surgery · Surgical oncology · Thoracic surgery · Trauma surgery · Urology · Vascular surgery

7 responses so far ↓

  • 1 ORSTALLION // Mar 17, 2008 at 3:07 pm

    crazy video!!! but can it stand up to the left ventricle??

  • 2 Jaime Landman // Mar 17, 2008 at 3:16 pm

    This is actually a video that I took from a Baxter advertisement. It is the type of anectotal information that biotech will push forward.

    I am not a cardiac surgeon, but this type of defect probably needs a formal closure. Certainly, I really appreciate Floseal in the OR and it is absolutely a wonderful adjunctive hemostatic technology, but big bleeds still need stitches, clips or staples.

    What physicians really need is well designed and controlled studies documenting the efficacy and indications for all of our surgical pharmaceuticals.

  • 3 Sammy // Mar 20, 2008 at 12:51 pm

    I don’t know if you have heard of this, but there is a bandage on the market called KytoStat. It is as easy to use as a regular bandage. All one does is apply it to the wound with pressure and it stops the bleeding. The white pad on the bandage when in contact with blood will stick to the wound and seal it. Although, I don’t think it’ll replace stitches, it is certainly being used by the military to stop severe bleeding wounds. Have you ever heard of it?

  • 4 Jaime Landman // Mar 20, 2008 at 4:05 pm

    I had heard of this bandage, but I have never used it. I think it is for external (superficial) wounds only and uses Chitosan as a hemostatic to go along with pressure. While people are saying that this is novel, the concept of a surgical pharmaceutical applied on a pressure bandage dates back over 100 years to Dr. Kurt Burgel who used fibrin coated bandages in combat situations.

  • 5 Tom // May 29, 2008 at 9:48 am

    I am surprised that Baxter would use such a video, as their Directions for Use state very clearly that this product is ” MUST NOT BE INJECTED into the blood stream”. I have to believe that would include the heart.

    I would be cautious in injecting ANY hemostasis product. Topical use is a different story…. You obviously are in the Baxter Camp!

  • 6 Jaime Landman // May 29, 2008 at 3:37 pm

    Thanks for you comment. The video was included only as it is very interesting and, quite frankly, an outrageous application. I think the entry and the subsequent discussions listed above clearly suggest that, and I am generally very critical about the claims made regarding most surgical pharmaceuticals. Regarding my “camp,” I am certainly heavily seeded in the “camp” of my patients, and no other. I have no Baxter relationship, and just truly believe that Floseal is currently the best hemostatic agent available. As my original entry suggest, there is little data to prove this. However, having done over 1500 advanced laparoscopic kidney cases it is my experience. Would love to know yours.

  • 7 IndustryGuy // Jun 10, 2008 at 3:38 pm

    Dr. Landman, I think you address the issue beautifully in your original post…there is a dearth of information. While we all preach the new favorite buzz phrase “evidence based medicine” is anyone really listening to the sermon? We (industry and physicians) still tend to be swayed by our allegiance and personal experience. It is clear that Tom is in another “camp” based on his rather antagonistic response. However, as someone in “Industry”, I can attest that it is an absolute “no-no” to preach off label use. Not knowing the story behind the video or how Baxter would intend to use it, I will reserve my judgment on whether it was creative advertising to demonstrate an extreme circumstance or just plain stupid.

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