RROLE OF CHITOSAN HEMOSTATIC DRESSING IN TRAUMA
Accidents and trauma are one of the leading causes of death and disability throughout the world. In developing countries like India, where emergency trauma care is still in its infancy, it accounts for almost 10% deaths every year. Lack of adequate pre-hospital care and uncontrolled bleeding from wound site are stated to be the prominent reasons for such deaths.¹
The pursuit of developing reliable and effective haemostatic dressings is an ongoing goal in the field of medical research. Chitosan, owing to its attractive attributes such as biocompatibility, antibacterial properties, antioxidants, haemostatic capabilities, and biodegradability, is frequently utilized within the biomedical industry.² The chitosan dressing serves as a haemostatic bandage designed to manage bleeding that cannot be controlled with a tourniquet, often due to the injury’s specific location. Given its properties, chitosan has found multiple applications in wound healing and has demonstrated its effectiveness as a haemostatic agent. Chitosan and its derivatives have the potential to expedite wound healing by enhancing the functions of inflammatory cells, including polymorphonuclear leukocytes (PMN), macrophages, fibroblasts, and osteoblasts.³
A study was conducted to assess the efficacy of Axiostat a novel chitosan-based haemostatic dressing, Axiostat is USFDA and CE approved haemostatic dressing. Axiostat was used as a haemorrhage control device in an ambulance setting. Axiostat and cotton gauze groups experienced hemostasis at 4.68 ± 1.04 and 18.56 ± 5.04 minutes, respectively. The time to hemostasis was dramatically shortened using Axiostat (p 0.0001). With Axiostat, a considerable decrease in blood loss was seen. In the chitosan-based bandage group, 94% of patients experienced successful hemostasis, compared to 74% in the cotton gauze group (p 0.05). (Fig 1). Additionally, using Axiostat had no side effects. However, three patients in the cotton gauze group did experience some adverse effects, such as tissue loss or rebleeding at the moment of removal.¹,²
Another observational study comparing the effectiveness of traditional cotton dressing with chitosan hemostatic treatment was conducted on patients with bleeding wounds selected at random. The findings indicated that hemostasis time in the cotton gauze group was 13.08 minutes, but it was 2.125 minutes in the dressing with chitosan bandage group. Only 61% of patients who had cotton gauze applied showed no following rebleeding removal, compared to 83% of patients with chitosan bandages. Overall patient as well as doctor’s comfort for application and removal of dressing was excellent in Axiostat as compared to Cotton Gauze (Fig 2).³
A prominent attribute of chitosan is their capacity to promote regeneration. Chitosan stimulates cell growth, encourages the organization of tissue architecture, and influences macrophage activity, all of
which contribute to accelerated wound healing. In summary, chitosan stands out as a highly promising material for haemostatic dressings, offering direct haemostatic benefits while potentially enhancing the wound healing process. Furthermore, it is noteworthy that chitosan does not exhibit any adverse biological responses.⁴
KEY TAKEAWAY MESSAGE
- Chitosan enables haemostasis rapidly, which helps in preventing significant blood loss during emergency trauma and accidents. It also allows easier removal from the wound site without leaving any residue, which helps render the wound clean.
- Chitosan’s putative capacity to induce clot formation without coagulation factors could be helpful in patients with coagulopathies or those who are therapeutically anticoagulated since chitosan maintains the haemostasis of heparinized blood.
- Axiostat clinical case studies axiostat-100% chitosan haemostatic dressing on transfemoral interventional cardiology procedure. Discussion. www.axiostat.com.
- Kabeer, M., Venugopalan, P. P. & Subhash, V. C. Pre-hospital Hemorrhagic Control Effectiveness of Axiostat® Dressing Versus Conventional Method in Acute Hemorrhage Due to Trauma. Cureus (2019) doi:10.7759/cureus.5527.
- Ketan, P. et al. Assessing the Efficacy of Haemostatic Dressing Axiostat® In Trauma Care at a Tertiary Care Hospital in India: A Comparison with Conventional Cotton Gauze. Indian Journal of Emergency Medicine 2, 93–99 (2016).
4. Pogorielov, M. V. & Sikora, V. Z. Chitosan as a Hemostatic Agent: Current State. European Journal of Medicine. Series B 2, 24–33 (2015).