Ankaferd BloodStopper (ABS) is a product claimed to have antihemorrhagic properties. It is used in hospitals and ambulances in Turkey to stop bleeding. In Goker et al, introduced Ankaferd Blood Stopper (ABS) as a new hemostatic drug. Recently, ABS has been shown to produce local. Elucidation of the Ankaferd Blood Stopper (ABS; Ankaferd Medical Products Inc, Istanbul, Turkey) as a topical hemostatic agent in the setting of epistaxis is.

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The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model 1. Conception of the study; acquisition, interpretation and analysis of data; manuscript writing. Conception of the study; acquisition, interpretation bloor analysis of data; histophatological examinations; manuscript writing. Conception of the sotpper acquisition, interpretation and analysis of data; manuscript writing; critical revision.

To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats. Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups.

In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group.

Bkood the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment lbood and the control group. The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats.

Surgery for lumbar disc herniations are performed over than one million patients all over the world in every year 1 – 2. The causes of failed stlpper syndrome are diskectomy for wrong level, recurrent or persistent disc herniation, iatrogenic instability, central or lateral stenosis, arachnoiditis, and spinal epidural fibrosis 3 – 5.

Epidural fibrosis cause nerve root traction, restricting of nerve root movements, extradural compression, and decreases the arterial supply of the nerve root. Impaired axoplasmic transport and excretion of inflammatory mediators following the decreasing of arterial supply lead to intractable radicular pain 1357.

Both back and radicular pain associated with the EF are resistant to physical, medical and surgical treatments 1 – 8. Epidural fibrosis is also associated with an increased complication rate in revision spine surgery 9 Epidural fibrosis is a part of the physiological tissue response after laminectomy.

Histologic studies have demonstrated that destruction of epidural fat, epidural hematoma accumulation and muscle invasion of ankafsrd laminectomy site are the main responsible factors for the formation of dense EF. The destruction of epidural fat results that duramater is exposed to neighboring structures and create a cavity where blood refill as hematoma.

Regarding to hypothesis, the inadequate control of epidural bleeding during surgical interventions is strongly associated with epidural fibrosis 45 The aim of this study is to investigate topically administered hemostatic agents, Ankaferd Blood Stopper ABS and Microporous Polysaccharide Hemospheres MPH can prevent epidural fibrosis and reduce arachnoideal involvement in a rat laminectomy model.

The surgical procedures were performed under general anesthesia. Rats were stabilized on the operation table in stopepr prone position after deep anesthesia. The lower back of each rat, which is the surgical site, was sterilized with povidone. Following sterile isolation, long posterior midline surgical incisions were performed between the L4 and L6 levels. The lumbar fascia was opened approximately Bilaterally, the paravertebral muscles were subperiostally dissected to expose the L laminae.


A total L5 laminectomy and flavectomy were performed, and epidural fat tissues were removed, leaving the duramater clean and fully exposed. The rats were then randomly allocated into three groups with six rats per group. After treatment, the wounds were primarily sutured in anatomical layers Prolen polypropylene sutures, Ethicon, Stoper Endo-Surgery, Inc.

Ankaferd blood stopper in episiotomy repair.

The rats had been then released for free food and water consumption for six weeks. The vertebral columns of the rats L were removed en bloc, including the whole laminectomy area, dural sacs, nerve roots, and paravertebral soft tissues.

Hemostasis had been achieved using cotton pad compression for several minutes. Any other hemostatic materials and bipolar cauterization were not applied. The specimen had been decalcified in a De Castro solution mixture: The specimens were examined under a light microscope.

Ankaferd BloodStopper

Grading of EF and arachnoidal involvement was performed according to the definition of He et al. The histological examination was conducted in a blinded manner by an experience examiner.

To determine the number of fibroblasts taken from the three separate sections on each laminectomized spine, three distinct regions on the surface area were determined as Six different areas were counted on each animal, and stereological analyses of fibroblasts were conducted according to the studies described previously For each animal, the number of fibroblasts in the selected areas listed was adapted by one mm 2.

Whether the distributions of continuous variables were normally or not was determined by using Kolmogorov-Smirnov test. Chi-squared test was used for analysis of nominal categorical data. If p value less than 0.

We did not observe any wound infection, abnormal foreign-body reaction, abscess formation, hematoma, or CSF leakages. All animals were ambulatory at the time of sacrification. The count of fibroblast results were calculated as Photomicrographs demonstrating fibrosis in the control group.

Direct contact between the ankafwrd spinal cord SC and the epidural fibrosis tissue F is evident. Photomicrographs demonstrating fibrosis in the MPH group. No direct contact between the underlying spinal cord SC and the epidural fibrosis tissue F is evident. Photomicrographs demonstrating fibrosis in the ABS group. The grading of EF was detected as 2. The gradings of arachnoidal involvement were detected as 2. Stereological methods are commonly used in research of the fibroblast regarding to experimental peripheral nerve injuries model, and it was showed that the stereological analysis techniques can supply correct and trustworthy estimates of fibroblast count and epidural fibrosis 15 – Previous studies suggested that the fibroblast cells in the fibrous tissue should be counted in three different areas, expressed as a mean value, and the fibroblast densities ankaferv be graded In our study, to determine the number of fibroblasts, we performed a stereological morphometric analysis of the fibroblast densities for three separate sections and six different areas were counted on each animal.

To the shopper of our knowledge, this is the first report about the stereological analyses of fibroblasts for the evaluation of the EF after laminectomy in the literature.

The first step for decreasing EF is achieving adequate hemostasis in surgical site. Bipolar coagulation and cotton are broadly using for hemostasis. However, cotton and coagulation on the surgical site may cause additional fibrosis and adhesion formation 18 – Although both the introduction of microsurgical techniques and stipper in bipolar coagulation technology ease to hemostasis, EF after laminectomy can still occur 45 To overcome this problem, several topical hemostatic agents were developed to prevent bleeding and achieve adequate hemostasis 620 – Hemostatic agents are more useful especially in the case of ooze bleeding with the risk of postoperative hematoma related to extensive EF.


Hemostatic agents using in neurosurgical interventions must have a strong hemostatic efficacy to provide durable hemostasis and also be degraded rapidly without tissue reaction or inflammation 321 It is formed into tightly engineered microporous particles with porosity and spherical diameters and was recently approved by the Food and Drug Administration for internal use.

Furthermore, it is shown that MPH reduces the incidence of surgical site infection It has been mostly used in surgeries on parenchymatous organs 2324but there is no reports about the application of MPH after laminectomy for the prevention of EF. This effect mostly related to its active hemostatic property.

We can conclude that MPH can be applied safely for hemostasis in the case of ooze bleeding into the laminectomy site with the risk of postoperative EF.

It is a standardized mixture of the agent containing various ratios of five herbal extracts: Each herb has effects on the endothelium, blood cells, angiogenesis, cell proliferation, and other physiologic mediators 26 – It blod shown that the ABS-induced network formation is related to hlood functions of blood proteins and red blood cells without destroying individual coagulation factors 26 – The basic mechanism of action for ABS is the formation of an encapsulated protein network that provides focal points for akaferd aggregation and forming a fibrin anakferd 27 Previous studies have performed its safety, efficacy, sterility, and non-toxicity for external usage for hemostasis 26 – However, its effects on the formation of the fibrous tissue are still controversial.

Some studies suggest that the topical application of ABS increased pericardial adhesion and fibrosis In another experimental study, ABS application did not increase intra-abdominal adhesion formation Our study demonstrated that the topical application of ABS did not increase EF after laminectomy in a rat model. Our results were similar with the previous studies which demonstrated the decreasing of adhesion formation after ABS application for hemostasis in the intra-abdominal surgeries This beneficial effect is mostly related to the hemostatic and anti-inflammatory activity of ABS.

The topical application of microporous polysaccharide hemospheres and ankaferd blood stopper significantly reduces EF formation, dural adhesion and fibroblast cell density in an experimental rat laminectomy model.

MPH and ABS, which have been previously used safely in humans for wound healing and parenchymatous organs hemostasis, “could be safely used for preventing epidural fibrosis after laminectomy in humans. Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis.

Failed back surgery syndrome: Seven- to year outcome of lumbar discectomy. Spine Phila Pa Influence of TachoComb in comparison to local hemostyptic agents on epidural fibrosis in a rat laminectomy model. Role of peridural fibrosis in the failed back: The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI.

Revision surgery for failed back stooper syndrome. Spine Phila Pa Aug;17 8: LaRocca H, Macnab I. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br. Anatomical effects on the spinal nerve root without and with fusion.

Spine Phila Pa Jun;18 8: Lumbar diskectomy for recurrent disk herniation.