Discussion
bleeding, Jonson & Johnson Products, coagulopathy
BLEEDING, COAGULOPATHY
This study was designed as a prospective, randomized study to compare CHM with a commonly used hemostatic agent, GHM, during CABG. Active flowable hemostatic matrices (CHM or GHM) contain thrombin and a particulate carrier in a single application product. These products work by blocking blood flow and actively converting blood fibrinogen into fibrin at the site of bleeding [Several prospective, randomized, controlled trials across numerous surgical areas have reported an active, flowable hemostatic matrix (GHM) to be a more effective hemostat, demonstrating faster hemostasis and better outcomes, than passive, non-flowable hemostatic agents (e.g., Gelfoam® an absorbable gelatin sponge, The Upjohn Co. Kalamazoo, MI, USA; Surgicel®, an oxidized regenerated cellulose, Jonson & Johnson Products, Inc, New Brunswick, NJ, USA) [Few studies have compared the clinical performance and outcomes of active, flowable, topical hemostatic matrices in cardiac surgery [Topical hemostatic agents may provide an economic advantage. Given the high cost associated with blood transfusion and its impact on hospital resources, the use of effective hemostats may be associated with potential cost savings due to reductions in transfusions [The available topical hemostatic agents have demonstrated variable efficacy, may require significant preparation time, and provide limited benefit in diffuse, aggressive or difficult-to-access bleeding sites. However, CHM can easily and quickly access bleeding sites due to its flowable nature and short preparation time of less than 20 s. These strengths can be applied in the surgical field.Our study includes some limitations. First, we had a small sample size. This fact may have led to a type II error, slightly narrowing the generalizability of the results found. Given the lack of clear differences between the two groups for ITT analysis, a larger number of patients is needed to evaluate the hemostatic superiority of both agents. Second, we did not conduct preoperative point of care testing for coagulopathy analysis. Third, this study had a short follow-up period; thus, the influence of the hemostats on the long-term clinical outcomes should be further evaluated. Lastly, we didn’t perform cost analysis in our trial, since this was not the focus of this research. It is known that CHM presents lower costs compared to GHM. We could say that in the future, it would be important to study our intervention with a bigger sample size and longer follow-up.