Glanzmann thrombasthenia: Use of hemocoagulase (BotroClot) for arrest of bleeding during a primary tooth endodontic procedure.

The Rationale: Glanzmann thrombasthenia is a rare platelet disorder affecting 0.0001% of the population. Dentists may often be unaware of this condition, and manipulation of soft tissue can lead to grave consequences, which may even result in fatality. Patient Concerns: In this case report, a 4-year-old patient with Glanzmann thrombasthenia reported to the department with a chief complaint of a discoloured tooth. Clinical Findings: On examination, 51 was nonvital, and pulpectomy was the treatment planned. The non-vital anterior tooth was treated with a pulpectomy procedure. There was uncontrolled bleeding during the procedure. Treatment: A topical solution of BotroClot was used to arrest the bleeding, and obturation was completed following that. The post-operative period was uneventful. Take-away Lessons: Case report explored the use of a topical hemostatic agent to arrest bleeding from the canal. This case report warrants eliciting a thorough medical history before any dental procedure.

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy.

AIM: To determine whether the injection of haemocoagulase into the biopsy tract can reduce pneumothorax and pulmonary haemorrhage after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). MATERIALS AND METHODS: A retrospective study was performed involving patients with undiagnosed pulmonary lesions scheduled for PTLB between January 2020 and March 2021. Patients were assigned to the haemocoagulase group or the non-haemocoagulase group. After CT-guided biopsies were performed with a 17 G coaxial system, patients in the haemocoagulase group received a haemocoagulase injection (0.2-0.5 units) in the biopsy tract as the sheath was withdrawn. Postoperative image studies were performed to evaluate complications, including pneumothorax and pulmonary haemorrhage. Factors, including the patient's position, lesion location, and pathological results, were evaluated to determine their associations with the complications. RESULTS: A total of 100 patients were included, with 44 men and a mean age of 53 years old. The overall incidences of pneumothorax and pulmonary haemorrhage were 15% and 13%, respectively. The incidences of pneumothorax and pulmonary haemorrhage were statistically significantly lower in the haemocoagulase group (8% and 6%, respectively) than in the non-haemocoagulase group (22% and 20%, respectively; p=0.04 and 0.03, respectively). There was no statistically significant difference in haemoptysis between the haemocoagulase (6%) and non-haemocoagulase (2%) groups (p=0.23). There were also no statistically significant associations of pneumothorax or pulmonary haemorrhage with the patients' positions, lesion location, or pathological results. CONCLUSION: Biopsy tract haemocoagulase injection reduced the incidences of postoperative pneumothorax and pulmonary haemorrhage after PTLB.

A comparative study between haemocoagulase and adrenaline in type 1 tympanoplasty.

INTRODUCTION: Haemostasis is a critical component of ear surgeries, which can be achieved by topical methods including simple manual pressure with gauze or cotton balls soaked with adrenaline, administration of haemostatic agents or vasoconstrictive materials. OBJECTIVE: To compare efficacy of haemocoagulase and adrenaline in attaining middle ear haemostasis in type - 1 tympanoplasty with or without cortical mastoidectomy. To study the effect of haemocoagulase in middle ear. MATERIALS AND METHOD: This is a prospective comparative study conducted in a tertiary care hospital from January 2013 to June 2014. Patients undergoing type 1 tympanoplasty with or without cortical mastoidectomy were divided into two groups. In group A (50 cases), cotton balls soaked in 2 ml Haemocoagulase was used and in group B (50 cases) cotton balls soaked in 2 ml Adrenaline (1:1000 dilution) was used for middle ear haemostasis. The efficacy of haemocoagulase and adrenaline was compared. RESULTS: The mean number of cotton balls used in haemocoagulase group in cases with congested middle ear mucosa was more than those used in the adrenaline group. Duration of surgery was more in haemocoagulase group (65 min) with congested mucosa, compared to adrenaline group (50 min). The mean blood pressure was significantly higher in adrenaline group compared to haemocoagulase group. Postoperative hearing improvement in both groups showed no significant difference with p value 0.694. CONCLUSIONS: Adrenaline is a better middle ear haemostatic than haemocoagulase. However, haemocoagulase can safely be used in patients with hypertension.

Effectiveness of topical haemocoagulase as a haemostatic agent in children undergoing extraction of primary teeth: a split-mouth, randomised, double-blind, clinical trial.

AIM: To assess the effectiveness of topically-administered haemocoagulase (batroxobin) (HC) following dental extractions in children. DESIGN: Split-mouth design, where either HC (test) or Normal Saline (control) (NS) was administered to children (5-9 years) requiring bilateral extractions of primary molars. Participants were randomised to (i) extraction sequence; (ii) test-solution administered thereafter. OUTCOME MEASURE: time taken (in seconds) for complete cessation of bleeding. RESULTS: Thirty participants completed the trial receiving HS (n = 30) and NS (n = 30). No adverse events were reported. Time to bleeding cessation was lower in HS group (82.5 ± 13.99 s) than NS group (240.5 ± 54.34 s). Difference between groups (paired t test) was statistically very highly significant (P = 0.000). CONCLUSION: Topical HC produced significant reductions in time for haemostasis and was clinically effective in controlling haemorrhage from extraction wounds in children. HC may be favourably utilised by paediatric dentists, especially with pre-cooperative or special-healthcare-needs patients, improving patient care.

Anaphylactic shock caused by haemocoagulase injection in China.

Haemocoagulase injection is a mixture of purified enzymes isolated from the venom of Bothrops atrox, which is used for the prevention and treatment of haemorrhage. It is a relatively safe pharmacological agent that does not require a skin test prior to administration. However, following a literature search, 14 reported cases of anaphylactic shock caused by haemocoagulase injection were identified, including one lethal case in China. Using SDS-PAGE and protein identification, four primary components in haemocoagulase injection were characterized, including one metalloproteinase, which may be a thromboplastin-like enzyme, and two serine proteinases, which may be thrombin-like enzymes. Administering concentrated haemocoagulase injections failed to provoke a positive skin reaction in allergic patients. Basophil activation tests revealed that haemocoagulase injections did not upregulate cluster of differentiation 63 or C-C chemokine receptor type 3 expression. These findings suggest that haemocoagulase injection may cause fetal anaphylaxis. Although it is difficult to determine a clear conclusion without being able to evaluate the patients that underwent haemocoagulase injection-induced shock, it is unlikely that the venomous components of haemocoagulase injection cross-react with common allergens in allergic patients. It is possible that haemocoagulase injection-induced anaphylaxis is caused by its additive components, such as mannitol and succinylated gelatin.

Separation and Purification of Haemocoagulase from Agkistrodon Blomhoffii in Changbai Mountain / 中国药师

Objective:To establish a method for the separation and purification of haemocoagulase from agkistrodon blomhoffii in Changbai Mountain. Methods: An enzyme component with clotting activity was isolated from the venin of agkistrodon blomhoffii in Changbai Mountain by gel filtration, anion-exchange chromatography and heparin-Sepharose affinity chromatography. SDS-Page and RP-HPLC were used to determine its purity, SDS-Page was applied to study its action mode with bovine fibrinogen, HPSEC was used to determine the molecular weight, an IEF method was employed to detect its isoelectric point, and Lowry method was used for the deter-mination of protein concentration. Results:One haemocoagulase was purified from agkistrodon in Changbai Mountain. SDS-Page dis-played one band, and HPLC showed one single chromatographic peak. The haemocoagulase acted only on α chain of fibrinogen. Its molecular weight was 32. 2kD with isoelectric point of 5. 21. The enzyme had clotting activity in vitro. Conclusion:The method can be used for the separation and purification of haemocoagulase from agkistrodon blomhoffii in Changbai Mountain.

Comparison of hemostatic effect and safety of injection of Agkistrodon acutus venom coagulation in liver resection / 重庆医学

Objective To compared hemostatic effect of agkistrodon haemocoagulase and other hemostatic agents in hepatectomy,and observe clinical safety.Methods From November 2014 to February 2016,122 patients undergoing hepatectomy of the department of hepatobiliary surgery in the hospital,according to the inclusion and exclusion criteria,were randomly divided into three groups,which was group A-haemocoagulase agkistrodon for injection,group B-ferdelance haemocoagulase for injection and group Cdesmopressin acetate injection.After drug administration,according to the clinical research plan,the indexes for therapeutic effectsbleeding time of wound,bleeding volume of wound,postoperative drainage volume for 24 h,preoperative and postoperative safety indices-Routine blood test,clotting function,liver and kidney function were compared among the three groups.Results The general data of the 3 groups were comparable.The bleeding time of wound,bleeding volume of wound,postoperative drainage volume for 24 h showed no significant difference(P＞0.05).Routine blood test,coagulation function,liver and kidney function,pre-admi nistration and post-administration administration of the group on the third day between and within groups were compared and showed no significant difference(P＞0.05).ECG and lower extremity ultrasound examination showed no abnormality in each group.No adverse events happened in the cases of groups for the clinical study.Conclusion Hemostatic effects of haemocoagulase agkistrodon for injection and other hemostatic drugs were similar in hepatectomy.No sinificant adverse effects on postoperative routine blood,coagulation function,liver and kidney function,with good efficacy and safety,being worthy of using widely worth in hepatectomy.

Effectiveness of intravenous haemocoagulase on haemorrhage control in bi-maxillary orthognathic surgery-A prospective, randomised, controlled, double-blind study.

Haemocoagulase is a snake venom protein derivative that is known to possess haemostatic activity. It is reported to minimise blood loss in orthopaedic, otorhinolaryngologic, and abdominal surgeries. The use of intravenous haemocoagulase in orthognathic surgery is unknown and not yet reported. The purpose of this trial is to study the efficacy of haemocoagulase in haemorrhage control in orthognathic surgery. Forty-six consecutive patients scheduled to undergo bi-maxillary orthognathic surgery within the time period of the study were recruited and randomized. They received either the study drug or placebo. All patients underwent operation with hypotensive anaesthesia. Intraoperative blood loss, operating time, drop in haemoglobin and haematocrit were the variables analysed in the study. Haemocoagulase caused an 11% (52 ml) reduction in blood loss in the study group (p = 0.01). There was no adverse reaction in any of the patients.

The Effects of Topical Hemocoagulase Solution on the Healing Process of Post-extraction Wounds: A Split Mouth Design.

OBJECTIVES: To evaluate the effects of topical hemocoagulase on intra-oral extraction sockets and impact on the healing process as well as to produce a clinico-histological healing score. STUDY DESIGN: This prospective study compared two extraction sites in each subject. One site received topical hemocoagulase while other site did not receive it. Both the sites were chosen in the same patient and extraction was done at separate intervals. The biopsy was done on a random basis with the pathologist being blinded to the study. Clinical evaluation was done on days 7, 14 and 21. Biopsy was done either on days 7 or 14 for the case as well as for the control. A clinical as well as histological score was developed and the healing was assessed. Statistical analysis was done using Wilcoxon signed rank test and p value ≤ 0.05 was considered significant and z-score was also calculated. RESULTS: The clinical score did not show any statistical significance. The histological total score on day 14 and combined overall analysis of days 7 and 14 showed statistical significance. There was an increased incidence (n = 4) of osteoid formation in the hemocoagulase group on day 14. CONCLUSION: The application of hemocoagulase may improve and accelerates the process of wound healing in extraction sockets.

Analysis of the Utilization of Perioperative Haemocoagulase Hemostatic Drugs in Our Hospital in 2014 / 中国药房

OBJECTIVE:To provide reference for the rational use of haemocoagulase hemostatic drugs in the clinic by under-standing the perioperative utilization. METHODS:In retrospective study,1 200 discharge records of perioperative prophylactic ap-plication of haemocoagulase hemostatic drugs were collected randomly during Jan.-Dec. 2014.,and then analyzed statistically in re-spects of consumption sum and amount,application,irrational drug use,etc. The cost of hemocoagulase accounted for 7.39% of total drug cost,among which Haemocoagulase agkistrodon for injection had the highest consumption amount and sum,with utiliza-tion ratio of 51.44%. Average medication time of hemocoagulase during perioperative period was 2.36d;maximal average cost of hemocoagulase was 684.52 yuan in ENT and head and neck surgery department/ stomatology department;ENT and head and neck surgery department/ stomatology department,urinary surgery department had long average medication time,being 3.85d and 3.50d. RESULTS:Only 39.42% haemocoagulase hemostatic drugs were reasonably used during perioperative period. The unreasonable manifestation included:improper medication time(52.15%), too long medication course after operation(35.75%),wrong usage (5.61%)and replacing various haemocoagulase hemostatic drugs without reason(5.06%). CONCLUSIONS:The striking phenome-non of irrational use of haemocoagulase hemostatic drugs during perioperative period is severely worrying,so we need to strength-en the standard management and pharmaceutical supervision and intervention by clinical pharmacists.

Observations on the Curative Effects of Haemocoagulase for TUPKVP on Patients with Reduced Coagulation / 中国药房

OBJECTIVE: To observe the curative effects of haemocoagulase on patients with reduced coagulation after the transurethraal plasmakentic vaporization of prostrate(TUPKVP).METHODS: 132 cases were randomly divided into two groups,one treated with haemocoagulase,and the other as control group.Then two groups were compared for the time of operation,quantity of blood transfusion during the operation and the time difference in continuous bladder-washing after the operation.RESULTS: There was an obvious difference(P