Simple clotting test to detect procoagulant abdominal swabs

Area of Science:

• Biomedical Engineering
• Surgical Materials Science
• Hematology

Background:

• Abdominal swabs are essential surgical tools for managing blood and tissues.
• While generally safe, some swabs possess procoagulant activity that can be hazardous during cardiac surgery with heart-lung machine (HLM) support.
• This heightened risk stems from potential abnormal clot formation, leading to life-threatening thromboembolic complications.

Purpose of the Study:

• To develop and validate a simple clotting test (SCT) for identifying abdominal swabs with excessive hypercoagulant potency.
• To assess the test's efficacy in detecting problematic swabs using heparinized human blood.
• To mitigate the risk of thromboembolic events in patients undergoing cardiac surgery with HLM.

Main Methods:

• Developed a SCT involving incubation of heparinized human blood from 100 donors with five types of abdominal swabs at 37°C for 30 minutes.
• Macroscopic analysis of blood clot formation was used to dichotomize results as positive (clot) or negative (no clot).
• Validated the SCT by screening 10 additional swabs (n=11) and employing scanning electron microscopy, activated clotting time, and thrombin-antithrombin measurements.

Main Results:

• Three out of five tested abdominal swabs demonstrated hypercoagulant potency in at least 25% of donors.
• Binomial distribution calculations indicated that 11 donors' blood is sufficient for routine SCT use.
• The second study confirmed the SCT's suitability for routine screening.

Conclusions:

• The developed SCT effectively detects abdominal swabs with elevated procoagulant potency.
• Implementing this test can significantly reduce the risk of thromboembolic complications in cardiac surgery patients requiring HLM support.
• This simple in vitro test offers a valuable tool for ensuring surgical material safety.