Documente Academic
Documente Profesional
Documente Cultură
Patient
Amr Aborahma , MD
Lecturer of Vascular Surgery
WHAT ARE YOUR EXPECTATIONS ?
Hemostasis in the Surgical Patient
Is It An Important Topic ?
From your point of view !!
Does All bleeding (eventually)
stops ?
Bleeding Clotting
Hemostasis
Vessels
Coagulation
Proteins Platelets
Fibrinolysis/ Inhibitors
Hemostasis
A process which causes bleeding to stop
Primary Hemostasis
Arteriolar vasoconstriction
Formation of platelet plug
Secondary Hemostasis
Activation of coagulation cascade
Formation of permanent plug
Constriction of vessels
Thrombomodulin
Antithrombin III
Tissue factor pathway inhibitor
Protein C
Protein S
Which is moving?
Natural inhibitors of the coagulation cascade
• Bleeding Time
• Clotting Time
-Vascular
Platelet Count -Platelet
PT -Coagulation factors
-Fibrinolysis
APTT
TT
Euglobulin Clot Lysis Time
D = Dimer
Clinical testing and preoperative screening
Gelfoam
– Absorbable
– Liquefies in 2-5
days
– Serves as a
scaffold for
coagulation
Oxidized regenerated cellulose
Surgicel
– Binds platelets and chemically precipitates
fibrin
Microfibrillar collagen
Decellularized bovine source
Stimulates latelet adhesion
Stops venous ooze
Absorbed in 90 days
Thrombin + Gelfoam + CaCl
Thrombin for cleavage/activation
Gelfoam as matrix
Very useful in vascular surgery
Fibrin glue
Tiseel
FDA approved in 1998
Concentrated fibrinogen and f VIII
Thrombin and calcium
Aprotinin to prevent clot dissolution
Takes time to prepare
Good for diffuse oozing, needle punctures,
parenchymal injuries
Questions
What is your feedback?
Thank You
Email: amr.aborahma@gmail.com