We then focused the study selection on 2 powder-based topical hemostatic agents that have been used endoscopically in the GI tract: Ankaferd BloodStopper® (ABS) and TC-325. Of note, microporous polysaccharide hemosphere has been used in Lumacaftor in vitro non-GIB with no clinical data in the literature on GI endoscopic application. Of 112 articles, 86 were on ABS, including 82 published articles in addition to 4 abstracts. Twenty-one articles
on ABS did not have any published abstracts. We also identified 5 published articles on TC-325 with 3 poster presentations. We briefly mention EndoClot for which all pertinent information was obtained through review of the manufacturer’s Web site, and at the time of writing this manuscript, no published peer-reviewed clinical data are available. Table 1 briefly outlines the composition and mechanisms of action of 3 hemostatic compounds of interest. A unique hemostatic agent, ABS is a derivative of a traditional ABT-199 nmr herbal mixture that has been used topically for centuries in Turkey to terminate bleeding resistant to conventional hemostatic measures.10
Currently ABS is available in 3 pharmaceutical forms: ABS ampoules, pads, and sprays.11 In May 2007, Ankaferd Ilac Kozmetik, AS, Turkey, obtained the marketing authorization from TC Ministry of Health, Drug, and Pharmacy General Directorate for all 3 forms within the category of “cosmetics, herbal products not aiming treatment, nutrition support products, nutraceutics and topically applied non-drug products.”12 There is no documented approval on the U.S. Food and Drug Administration Web site.13 However, according to the Ankaferd
Web page, second ABS can be used in various areas, including dental offices, emergency departments, schools, and first aid kits.14 Additional information could not be collected because the manufacturer did not respond to our further queries. A preparation of 100 mL of ABS is composed of a standardized mixture of plants, including 5 mg Thymus vulgaris (dried grass extract), 9 mg Glycyrrhiza glaba (dried leaf extract), 8 mg Vitis vinifera (dried leaf extract), 7 mg Alpinia officinarum (dried leaf extract), and 6 mg Urtica dioica (dried root extract). 15 The mechanism of action involves ABS interaction with the endothelium and blood cells, in addition to its influence on angiogenesis, cellular proliferation, vascular dynamics, 16, 17, 18 and 19 and cell mediators. 20, 21 and 22 Yilmaz et al 23suggested that ABS hemostatic actions could be related to its rapid induction (<1 s) of a protein network in human plasma and serum samples. On electron microscopy, erythrocytes and leukocytes aggregate rapidly in the presence of ABS and further contribute to a scaffold formation. Indeed, in vitro examination suggests ABS stimulates the formation of the encapsulated protein scaffold network, 15 and 21 allowing erythrocyte aggregation that then integrates with the classic coagulation cascade.