Bioelastic membranes for topical application of a thromboxane synthetase inhibitor for protection of skin from pressure injury: a preliminary study

A previous study showed that topical exposure to bioelastic-thromboxane synthetase inhibitor-matrix resulted in local tissue concentrations of thromboxane synthetase inhibitor sufficient for thromboxane synthetase inhibition. The objective of this research was to use an animal model to determine if a dressing having controlled release of thromboxane synthetase inhibitor (dazmegrel) could be used to prevent tissue breakdown over pressure points, i.e., lesion at the assistive device-skin interface. The animal model studies utilized the greyhound, a dog that has thin skin, angular conformation, limited body fat and is predisposed to pressure ulcers similar to those occurring in humans. The model uses a short-limb walking cast on one pelvic limb with the severity of the dermal pressure lesions induced over the medial malleolus controlled by the amount of padding in the cast and length of time the cast is in place. The bioelastic matrix loaded with dazmegrel provided protection from shearing and pressure skin injury over the medial malleolus, as evidenced by a decrease in epidermal abrasion/ulceration as measured with planimetry. Histopathologic evaluation of the skin over the medial malleolus indicated a protective function of the bioelastic matrix as measured as lower numbers of neutrophils, lymphocytes, and decreased collagen density compared to such numbers when no bioelastic matrix was present. These studies provided evidence that bioelastic-thromboxane sythetase inhibitor- matrix helps in preventing or reducing the severity of pressure lesions, e.g., assistive device-skin interface wounds.     

Heparin therapy in venous thrombosis

DVT has been reported to occur in up to 42% of trauma patients. Complications of DVT can include PE, which may lead to death. DVT treatment can be accomplished pharmacologically with UH, LMWH, and thrombolytics. Thrombolytics have a high adverse event profile and are contraindicated in many patients, which limits their usefulness in practice. UH is widely used for its favorable adverse effect profile with careful monitoring of the APTT, ease of rapid anticoagulation by using one of several heparin-dosing nomograms, and proven track record in the prevention of DVT extension and recurrence. Drawbacks of UH include frequent changes in dosing while titrating anticoagulant effect, frequent laboratory monitoring of the APTT, and increased risk of bleeding. In the future the use of LMWH may increase to treat DVT because of fixed-dose administration, once or twice daily dosing, and lack of laboratory monitoring. Studies have shown a reduced risk of major bleeding and a decreased recurrence of DVT when LMWHs are compared with UH. Further studies are needed to determine whether LMWH will become the mainstay of treatment for DVT.