Histopathological Evaluation of Liver Tissue Post-Treatment with Hemostatic Agents in Hyperfibrinolysis-Induced Injury: A Comparative Study: Hemostatic Agents in Hyperfibrinolytic Liver Injury

Hamid Ali Memon; Allah Bux Kachiwal; Mool Chand Malhi; Mansoor Tariq; Tamseel Saleem

doi:10.54393/fbt.v5i2.169

Authors

Hamid Ali Memon Department of Veterinary Physiology and Biochemistry, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, Pakistan
Allah Bux Kachiwal Department of Veterinary Physiology and Biochemistry, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, Pakistan
Mool Chand Malhi Department of Veterinary Physiology and Biochemistry, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, Pakistan
Mansoor Tariq Department of Veterinary Pathology, Sindh Agriculture University, Tandojam, Pakistan
Tamseel Saleem Department of Physiology and Biochemistry, Sindh Agriculture University, Tandojam, Pakistan

DOI:

https://doi.org/10.54393/fbt.v5i2.169

Keywords:

Liver Trauma, Hyperfibrinolysis, Hemostatic Agents, Surgiflo, Tissue Healing

Abstract

Liver trauma complicated by hyperfibrinolysis leads to uncontrolled hemorrhage and systemic coagulopathy, posing significant challenges in clinical management. Objective: To analyze histopathological and clinical changes in hepatic tissue after using hemostatic agents TXA, OCR, and Surgiflo to examine volume of blood loss, duration of blood loss, tissue healing, fibrosis, and inflammation. Methods: A total of 48 rabbits were systematically assigned to four distinct cohorts placing 12 rabbits in each group: Control, Tranexamic Acid (TXA), Oxidized Regenerated Cellulose (ORC), and Surgiflo. Uniform hepatic injuries were surgically induced in all liver specimens. After that, each cohort had the prescribed course of treatment. Time to hemostasis, blood loss volume, D-dimer levels, survival rate, and liver tissue histology were the primary outcomes that were measured. Results: Out of all the groups, Surgiflo had the quickest hemostasis and the least amount of blood loss. The Surgiflo and ORC groups showed better tissue healing, with less fibrosis and mild inflammation, according to histological analysis. The TXA and Control groups, on the other hand, had slower tissue healing and more infiltration of inflammatory cells. Conclusions: Surgiflo was found to be the most successful treatment for liver damage with hyperfibrinolysis based on both clinical and histological results. The outcomes validate its application as a dependable choice for reducing hemorrhage and encouraging tissue repair in cases of complicated liver damage.

References

Bugaev N, Como JJ, Scalea TM. Hyperfibrinolysis in trauma: Pathophysiology and clinical implications. Journal of Trauma and Acute Care Surgery. 2021 Aug; 90(4): e85-e90. doi: 10.1097/TA.0b013e31825c1234.

Moore HB, Moore EE, Neal MD, Sheppard FR, Kornblith LZ, Draxler DF et al. Fibrinolysis shutdown in trauma: historical review and clinical implications. Anesthesia & Analgesia. 2019 Sep; 129(3): 762-73. doi: 10.1213/ANE.0000000000004234.

Michalopoulos GK. Hepatostat: Liver regeneration and normal liver tissue maintenance. Hepatology. 2017 Apr; 65(4): 1384-92. doi: 10.1002/hep.28988.

Mazza G, Al‐Akkad W, Rombouts K, Pinzani M. Liver tissue engineering: From implantable tissue to whole organ engineering. Hepatology communications. 2018 Feb; 2(2): 131-41. doi: 10.1002/hep4.1136.

Horvatits T, Tamminga M, Liu B, Sebode M, Carambia A, Fischer L et al. Microplastics detected in cirrhotic liver tissue. EBioMedicine. 2022 Aug; 82. doi: 10.1016/j.ebiom.2022.104147.

Datta D, Bandi SP, Colaco V, Dhas N, Saha SS, Hussain SZ et al. Cellulose-Based Nanofibers Infused with Biotherapeutics for Enhanced Wound-Healing Applications. ACS Polymers Au. 2025 Feb; 5(2): 80-104. doi: 10.1021/acspolymersau.4c00092.

Gayet-Ageron A, Prieto-Merino D, Ker K, Shakur H, Ageron FX, Roberts I et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. The Lancet. 2018 Jan; 391(10116): 125-32. doi: 10.1016/S0140-6736(17)32455-8.

Kunitake RC, de Moya MA, King DR. Emerging pharmacologic therapies in the management of traumatic bleeding. Current Trauma Reports. 2024; 10(1): 1-9. doi: 10.4103/tjem.tjem_164_24.

Pickkers P, Darmon M, Hoste E, Joannidis M, Legrand M, Ostermann M et al. Acute kidney injury in the critically ill: an updated review on pathophysiology and management. Intensive Care Medicine. 2021 Aug; 47(8): 835-50. doi: 10.1007/s00134-021-06454-7.

Hoffbrand AV. Hoffbrand's essential haematology. John Wiley & Sons. 2024.

Grover SP, Schmedes CM, Auriemma AC, Butler E, Parrish ML, Miszta A et al. Differential roles of factors IX and XI in murine placenta and hemostasis under conditions of low tissue factor. Blood Advances. 2020 Jan; 4(1): 207-16. doi: 10.1182/bloodadvances.2019000921.

Oguntoye CO and Oke BO. Evaluation of anesthesia with xylazine-ketamine and xylazine-fentanyl combinations in rabbits. Nigerian Veterinary Journal. 2018; 39(2): 144-50.

Al-Massody MJ, Al-Badrany YM, Ali YH. Ketamine-Xylazine anesthesia in rabbits. Iraqi Journal of Veterinary Sciences. 2015; 29(1): 31-6.

Ugur F. Evaluation of ketamine-xylazine anesthesia in rabbits. Veteriner Fakültesi Dergisi. 2020; 46(3): 345-9.

Guo Y, Wang M, Liu Q, Liu G, Wang S, Li J. Recent advances in the medical applications of hemostatic materials. Theranostics. 2023 Jan; 13(1): 161. doi: 10.7150/thno.79639.

Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. British Medical Journal. 2012 May; 344. doi: 10.1136/bmj.e3054.

Lukes AS, Moore KA, Muse KN, Gersten JK, Hecht BR, Edlund M et al. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstetrics & Gynecology. 2010 Oct; 116(4): 865-75. doi: 10.1097/AOG.0b013e3181f20177.

Pabinger I, Fries D, Schöchl H, Streif W, Toller W. Tranexamic acid for treatment and prophylaxis of bleeding and hyperfibrinolysis. Wiener klinische Wochenschrift. 2017 May; 129: 303-16. doi: 10.1007/s00508-017-1194-y.

Sano H. Hemostatic effects of tranexamic acid and oxidized regenerated cellulose in rat liver laceration model. Surg Today. 2019; 49(11): 917-24.

Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. III. The post-operative period. Blood Transfusion. 2011 Jul; 9(3): 320. doi: 10.2450/2011.0076-10.

Grottke O, van Ryn J, Spronk HMH, Henskens YMC, Rossaint R. New oral anticoagulants in trauma patients: a review of current evidence and clinical implications. Critical Care. 2022; 26(1): 1-12. doi: 10.1186/s13054-022-04001-2.

Pang FS, Liaw EY, De S. Comprehensive management of Jehovah's Witness in pregnancy. Postgraduate Medical Journal. 2023 Oct; 99(1176): 1068-75. doi: 10.1093/postmj/qgad047.

Okeke T. Randomized trial of tranexamic acid in preventing postpartum hemorrhage. International Journal of Gynecology & Obstetrics. 2018 Dec; 142(3): 345-50. doi: 10.18203/2320-1770.ijrcog20185401.

Gasparri M. Laparoscopic sentinel lymph node mapping in endometrial cancer. 2017 Oct; 143(10): 2039-2048. doi: 10.1007/s00432-017-2501-8.

Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Filipescu D et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Critical Care. 2023; 27(1): 1-56. doi: 10.1186/s13054-023-04399-7.

Roberts I, Shakur-Still H, Afolabi A, Brenner A, Chaudhri R, Coats T et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. The Lancet. 2020; 376(9734): 23-32. doi: 10.1016/S0140-6736(10)60835-5.

Ethicon. SURGICEL® Original Absorbable Hemostat [Internet]. J&J MedTech; 2021 [cited at: 18th MaY 2025]. Available from: https://www.jnjmedtech.com/en-US/product/surgicel-original-absorbable- hemostat.