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Control of hepatic bleeding with microfibrillar collagen.

Microfibrillar (Avitene) is a new absorbable topical hemostatic agent whose mechanism of action is platelet entrapment and activation of platelet clotting factors. It adheres to moist tissue surfaces to form a firm, flexible hemostatic coagulum. It has been used clinically in 36 patients with hepatic bleeding of diverse etiology, including bleeding from the gallbladder fossa, lacerations, resectional surfaces, biopsy sites, capsular denudations, and hepatic tumors. Although not intended to control major hemorrhage were major vessel ligation or resection is properly indicated, its topical use for diffuse small vessel bleeding may be life-saving. It is exceptionally useful in such conditions as cirrhosis and in thrombocytopenic or thrombasthenic coagulopathies. One treatment failure out of 36 occurred.