TITLE: WoundClot® Hemostatic Gauze Reduces Bleeding Time after Arterial Venous Fistula Decannulation.

INTRODUCTION: Decannulation of the arteriovenous fistula (AVF) after each hemodialysis session requires a precise compression on the needle puncture site. The objective of our study was to evaluate the bleeding time (BT) needed to achieve hemostasis using WoundClot, an innovative hemostatic gauze, and to assess whether its long-term use can improve AVF preservation.

METHODS: This is a prospective single center study. Initially, the time to hemostasis after AVF decannulation was compared between WoundClot and cotton gauze in 24 prevalent hemodialysis patients. Thereafter, the patients continued to use WoundClot for 12 months and were compared to a control group consisting of 25 patients using regular cotton gauze. Follow-up data included parameters of dialysis adequacy, AVF interventions, and thrombotic events.

RESULTS: WoundClot use shortened significantly the time needed for hemostasis. Mean venous BT decreased by 3.99 (±4.6) min and mean arterial BT by 6.38 (±4.8) min when using WoundClot compared to cotton gauze (p < 0.001). At the end of the study, dialysis adequacy expressed by spKt/V was higher in the WoundClot group compared to control (1.73 vs. 1.53, respectively, p = 0.047). Although patients in WoundClot group had a higher baseline BT, arterial and venous pressures did not differ between the groups after a median follow up of 10.8 months. AVF thrombosis rate was similar between the groups.

CONCLUSIONS: WoundClot hemostatic gauze significantly reduced the time required for hemostasis after AVF decannulation and may be associated with better AVF preservation. We suggest using WoundClot for arterial BT longer than 15 min and for venous BT longer than 12.5 min.

SOURCE: Kliuk-Ben Bassat O, Schwartz D, Zubkov A, et al. WoundClot® Hemostatic Gauze Reduces Bleeding Time after Arterial Venous Fistula Decannulation. Blood Purif. 2021 : 1-7. 

简介：每次血液透析后，动静脉内瘘（AVF）的拔针需要在穿刺针处精确加压。我们研究的目的是评估使用创新的止血纱布WoundClot止血所需的出血时间（BT），并评估其长期使用是否可以改善AVF的保留。

方法：这是一项前瞻性单中心研究。最初，比较了24例正进行的血液透析患者中​​WoundClot和棉纱布在AVF拔针后达到止血的时间。此后，患者继续使用WoundClot 12个月，并与由25名使用常规棉纱布的患者组成的对照组进行比较。随访数据包括透析充分性，AVF干预和血栓形成事件的参数。

结果：WoundClot的使用大大缩短了止血所需的时间。与棉纱布相比，使用WoundClot时平均静脉BT减少了3.99（±4.6）分钟，平均动脉BT减少了6.38（±4.8）分钟（p <0.001）。在研究结束时，与对照相比，WoundClot组中spKt / V表达的透析充分性更高（分别为1.73和1.53，p = 0.047）。尽管WoundClot组的患者具有较高的基线BT，但在中位随访10.8个月后两组之间的动脉和静脉压力没有差异。两组之间的AVF血栓形成率相似。

结论：WoundClot止血纱布可显著减少AVF拔针后止血所需的时间，并可能与更好的AVF保留有关。我们建议将WoundClot用于超过15分钟的动脉BT和超过12.5分钟的静脉BT。

启发：特殊耗材可缩短止血时间，也有利于内瘘的保留。但我们不可忽视由于内瘘自身病变导致的止血时间延长。