a kaolin-based hemostatic gauze as an adjunctive tool for bleeding control after vascular closure devices use in tavi patients

Research Article
Daniela Trabattoni*, Franco Fabbiocchi, Paolo Olivares, Giacomo Basadonna, Giuseppe Calligaris, and Antonio Bartorelli
Hemostasis; Kaolin-based gauze; Vascular closure Device; TAVI

Objectives: To assess effectiveness of minor bleeding control with a kaolin-based hemostatic gauze after vascular closure devices (VCDs) use in patients undergoing transcatheter aortic valve implantation (TAVI).

Background: Large arterial sheath size use in TAVI pts may lead to major vascular complications and bleeding. New hemostatic dressings have been developed and there is a growing interest in their potential applications.

Study Design: Prospective, single center study. Methods: Forty-five patients (56% men, mean age 82.7±5) underwent TAVI by femoral approach with a mean sheath size of 18.3±1.3 F (18/19 F=89%; 22/24 F=11%). Patients were on aspirin (90%), aspirin + clopidogrel (7.5%) or LMWH (2.5%). Results: Mean ACT value was 180±24 seconds. Femoral hemostasis was achieved with a double suture-based VCD deployment in 30 (67%) patients or a double VCD with cross-over balloon inflation in the remaining 15 (33%) patients. Bleeding after VCDs occurred in 15 (33%) pts. The kaolin-based dressing, activates the intrinsic blood coagulation pathway thus allowing for a short manual hemostasis period. The gauze was applied for 3 minutes above the puncture site obtaining complete and fast bleeding control.

Conclusions: The kaolin-gauze demonstrated to be effective in minor bleeding control after large arterial sheath removal with a VCD.