Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/715—Polysaccharides, i.e. having more than five saccharide radicals attached to each other by glycosidic linkages; Derivatives thereof, e.g. ethers, esters
  • A61K31/716—Glucans
  • A61K31/721—Dextrans
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/04—Antihaemorrhagics; Procoagulants; Haemostatic agents; Antifibrinolytic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/06—Aluminium, calcium or magnesium; Compounds thereof, e.g. clay
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/14—Alkali metal chlorides; Alkaline earth metal chlorides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
  • A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
  • A61L15/18—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons containing inorganic materials
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L26/00—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L26/00—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form
  • A61L26/0004—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form containing inorganic materials
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/20—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing organic materials
  • A61L2300/204—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing organic materials with nitrogen-containing functional groups, e.g. aminoxides, nitriles, guanidines
  • A61L2300/208—Quaternary ammonium compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/418—Agents promoting blood coagulation, blood-clotting agents, embolising agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2400/00—Materials characterised by their function or physical properties
  • A61L2400/04—Materials for stopping bleeding

Definitions

• the invention relates to the field of hemostatic compositions. More particularly, the invention relates to hemostatic compositions comprising an anion exchanger and calcium; and methods of use thereof.
• Bleeding is the term commonly used to describe the escape of blood from the circulatory system of a vertebrate. Bleeding may occur inside the body (internal bleeding) or outside the body (external bleeding). The site of bleeding can be almost any area of the body. Typically, internal bleeding occurs when blood leaks out through damage to a blood vessel or organ. External bleeding occurs either when blood exits through a break in the skin, or when blood exits through a natural opening in the body, such as the mouth, nose, ear, vagina, or rectum.
• Bleeding may be caused by a wide variety of incidents or conditions, including traumatic injury (including abrasions, grazes, lacerations, incisions, puncture wounds from items such as a needle or a knife, crushing injuries and gunshot wounds) or certain medical conditions, such as those associated coagulations compromised subjects which have deficiencies of coagulation factors. Additionally, bleeding may be caused by use of certain medicaments, such as some non-steroidal anti-inflammatory drugs (NSAIDs) or anticoagulation drugs e.g. warfarin, low molecular weight heparin, Apixaban (ELIQUIS®), Dabigatran (PRADAXA®), Edoxaban (SAVAYSA®) and) Rivaroxaban (XARELTO®).
• NSAIDs non-steroidal anti-inflammatory drugs
• ELIQUIS® Apixaban
• PRADAXA® Dabigatran
• SAVAYSA® Edoxaban
• Rivaroxaban XARELTO®
• hemostasis The stopping or controlling of bleeding is referred to as hemostasis, which involves blood coagulation, and promoting, accelerating or enhancing this mechanism, is an important part of both, first aid and surgery.
• Agents and compositions which enhance, promote or accelerate hemostasis are referred to as "hemostatic agents".
• Hemostatic agents may comprise hemostats, sealants or adhesives. Typically, hemostats are subdivided into mechanical hemostats (gelatin, collagen, oxidized regenerated cellulose, etc.), active hemostats (such as thrombin), flowable hemostats (such as gelatin matrices in conjunction with thrombin), and fibrin sealants.
• mechanical hemostats such as thrombin
• active hemostats such as thrombin
• flowable hemostats such as gelatin matrices in conjunction with thrombin
• fibrin sealants such as fibrin sealants.
• hemostats require lengthy preparation prior to use, involving numerous steps, which waste valuable time in emergency situations.
• hemostats are ineffective for patients who are using blood-thinning medications, such as heparin, Aspirin or Coumadin.
• hemostats include procoagulants, which carry a potential risk of contamination, have high production costs, short expiration time and usually require refrigeration.
• the present invention provides a hemostatic composition
• a hemostatic composition comprising an anion exchanger; calcium and a pharmaceutically acceptable carrier, as well as methods of use thereof for inducing hemostasis.
• a method for inducing hemostasis at a site of bleeding in a subject in need thereof comprising applying to the site of bleeding an effective amount of a hemostatic composition comprising an anion exchanger and a calcium salt.
• the anion exchanger comprises one or more positively-charged groups bound to a matrix.
• the positively-charged groups also referred to as polycations
• a base selected from the group consisting of a strong base, a weak base and a combination thereof.
• the strong base comprises quaternary amino groups.
• the weak base comprises an amino group selected from the group consisting of a primary amino group, a secondary amino group, a tertiary amino group and a combination thereof.
• the weak base consists of Diethylaminoethyl (DEAE) groups.
• the matrix is selected from the group consisting of an aliphatic polyester, a polysaccharide, a polypeptide, polystyrene-divinylbenzene, a protein (such as collagen gelatin or albumin), silica and a combination thereof.
• the matrix is cross-linked, optionally covalently cross-linked.
• the composition is substantially devoid of any protein of the blood clotting cascade.
• the composition is in a form selected from the group consisting of a slurry, powder, fiber, film, patch and liquid.
• the composition in the form of slurry or liquid further comprises a pharmaceutically acceptable carrier.
• applying is carried out by applying pressure on the composition, optionally towards the site of bleeding.
• a hemostatic composition comprising an anion exchanger; a calcium salt; and optionally, a pharmaceutically acceptable carrier.
• the anion exchanger comprises one or more positively-charged groups bound to a matrix.
• the anion exchanger is linked to a solid phase.
• the positively-charged groups consist of a base selected from the group consisting of a strong base, a weak base and a combination thereof.
• the strong base comprises quaternary amino groups.
• the weak base comprises an amino group selected from the group consisting of a primary amino group, a secondary amino group, a tertiary amino group and a combination thereof.
• the weak base consists of Diethylaminoethyl
• the matrix is selected from the group consisting of an aliphatic polyester, a polysaccharide, a polypeptide, polystyrene-divinylbenzene, silica and a combination thereof.
• the matrix is cross-linked, optionally covalently cross-linked.
• the polysaccharide is selected from the group consisting of cellulose, dextran, agarose, and combinations thereof.
• the protein is a structural protein such as collagen or gelatin, or proteins having high abundance in blood plasma such as albumin.
• the composition is substantially devoid of any protein of the blood clotting cascade.
• the composition is in a form selected from the group consisting of a slurry, powder, film, patch and liquid.
• the composition in the form of slurry or liquid further comprises a pharmaceutically acceptable carrier.
• a hemostatic composition comprising Diethylaminoethyl (DEAE) bound to a matrix; and a calcium salt.
• DEAE Diethylaminoethyl
• a method for the preparation of a hemostatic composition comprising preparing an anion exchanger by covalently binding one or more positively-charged groups to a cross- linked matrix; and adding a calcium salt to said anion exchanger.
• a hemostatic composition obtainable by the method disclosed herein.
• inducing hemostasis refers to causing, bringing about, promoting, accelerating and/or enhacing hemostasis.
• a site of bleeding refers to a site that is actively bleeding and to a site that may be prone or susceptible to bleeding complications such as for example a surgical site, anastomotic site, and/or suture site.
• the term "pharmaceutically acceptable carrier” refers to any inert diluent or vehicle which has no biological activity and which is suitable for use in humans or other animals.
• the carrier may be selected from any of the carriers known in the art such as, but not limited to, phosphate buffered solution (PBS), saline, sodium chloride solution, calcium chloride solution, lactated ringers (LR), 5% dextrose in normal saline, different saccharides, sugar alchols (such as mannitol, sorbitol) and water for injection.
• PBS phosphate buffered solution
• saline sodium chloride solution
• calcium chloride solution calcium chloride solution
• lactated ringers (LR) lactated ringers
• 5% dextrose in normal saline different saccharides
• sugar alchols such as mannitol, sorbitol
• water for injection water for injection.
• slurry refers to a thick, soft, moist substance.
• a slurry is produced by mixing dry ingredients (e.g. powder or solid hydrophillic particles) with a liquid.
• the dry ingredients concentration can be 0.5 % to 99% w/w of the entire slurry composition.
• a slurry is a moldable material in the temperature range of 15-40°C.
• the term "devoid of with regard to a component of a composition refers to a component which is present in the composition at a concentration of less than 0.1% w/w of the total composition.
• Fig. 1 shows reduction in bleeding in an in-vivo heparinized porcine spleen circular punch model (4 mm diameter/2 mm depth) following application of DEAE SEPHADEXTM A- 50 (10% w/v) and a commercial gelatin hemostat, with a compression time of 30 seconds (for DEAE SEPHADEXTM A-50) or 60 seconds (for commercial gelatin hemostat).
• Fig. 2a shows a device used for a Porcine Spleen Problematic Bleeding Model in order to create a "bullet-like" wound.
• Fig. 2b shows a wound created by the device of Fig. 2a in a porcine spleen. As can be seen in Fig. 2b, the wound results in severe bleeding from the spleen.
• DEAE SEPHADEXTM A-50 was prepared as a slurry of 10% w/v in 20 mM CaCl 2 and applied to the wound. Following the application of the slurry, and compression time of 4 minutes, the Post- Application Bleeding Intensity was evaluated as described for Fig. 1.
• Fig. 2c shows the bullet-like wound following application of DEAE SEPHADEXTM A-50 and tamponade, which achieved complete hemostasis of the severely bleeding wound.
• the present invention provides a hemostatic composition
• a hemostatic composition comprising an anion exchanger; a calcium salt and optionally, a pharmaceutically acceptable carrier, as well as methods of use thereof in achieving hemostasis.
• a method for inducing hemostasis in a subject in need at a site of bleeding comprising applying to the site of bleeding an effective amount of a hemostatic composition comprising an anion exchanger and a calcium salt.
• a hemostatic composition comprising an anion exchanger and a calcium salt for use in inducing, hemostasis at a site of bleeding.
• a hemostatic composition comprising an anion exchanger and a calcium salt in the manufacture of a medicament for inducing hemostasis.
• a hemostatic pharmaceutical composition comprising an anion exchanger and a calcium salt in the manufacture of a medicament for inducing hemostasis.
• the anion exchanger comprises one or more positively- charged groups (at a pH between 2 to 10) (also referred to as polycations) bound to a matrix.
• the hemostatic composition is devoid of polyanions.
• the anion exchanger comprises one or more positively-charged groups (at a pH between 2 to 10) (also referred to as polycations) bound to a matrix.
• the hemostatic composition is devoid of polyanions (such as polyanionic polymers).
• Polyanions are molecules or chemical complexes having more than one negative charge.
• Polycations are molecules or chemical complexes having more than one positive charge.
• the matrix may include anionic residues; however, the overall net charge of the anion exchanger will be positive.
• the positively-charged groups are present in the hemostatic composition at a total ionic capacity of not less than 2 mmol/g, e.g. between 2 to 5, 3 to 4mmol/g.
• total ionic capacity refers to the total amount of charged sites in the composition which are available for exchange. Total ionic capacity is expressed on a dry weight, wet weight or wet volume basis.
• the anion exchanger is present at a concentration of 0.5-99% w/v of the total hemostatic composition, optionally at a concentration of 5-15% w/v of the total hemostatic composition, such as, for example, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13% 14% or 15%.
• a ratio between the anion exchanger and the calcium in the hemostatic composition is in the range of between 1 :5 to 1 :70. In some embodiments, the ratio is about 1 :34.
• the positively-charged groups consist of a base selected from the group consisting of a strong base (such as one comprising quaternary amino groups), a weak base (such as one comprising an amino group selected from the group consisting of a primary amino group, a secondary amino group, a tertiary amino group) and a combination thereof.
• a strong base such as one comprising quaternary amino groups
• a weak base such as one comprising an amino group selected from the group consisting of a primary amino group, a secondary amino group, a tertiary amino group
• the weak base consists of Diethylaminoethyl
• the positively-charged groups are bound to the matrix e.g. matrix support via a linker present between the matrix support and the positively charged groups.
• the matrix is selected from the group consisting of a an aliphatic polyester, a polysaccharide, a polypeptide (such as gelatin, bovine serum albumin (BSA) or collagen, or combinations thereof), polyacrylamide, acrylate-copolymer, polystyrene-divinylbenzene, silica and a combination thereof.
• a polysaccharide such as gelatin, bovine serum albumin (BSA) or collagen, or combinations thereof
• BSA bovine serum albumin
• polyacrylamide acrylate-copolymer
• polystyrene-divinylbenzene silica and a combination thereof.
• the matrix is cross-linked, optionally covalently cross-linked.
• the matrix is devoid of ionic cross-linkages.
• the polysaccharide is selected from the group consisting of cellulose, dextran, agarose, and combinations thereof.
• the matrix comprises SEPHADEXTM (dextran), SEPHACELTM (cellulose) or TOYOPEARLTM (hydroxylated methacrylic polymer) or combinations thereof.
• the composition is in a form selected from the group consisting of a slurry, powder, film, patch and liquid. According to some such embodiments, wherein the composition in the form of slurry or liquid, the composition further comprises a pharmaceutically acceptable carrier.
• applying of the hemostatic composition to the site of bleeding is carried out by applying pressure (e.g. with gauze) on the composition towards a site of bleeding.
• a hemostatic composition comprising an anion exchanger; a calcium salt; and optionally, a pharmaceutically acceptable carrier.
• the anion exchanger comprises one or more positively-charged groups (also referred to as polycations) bound to a matrix.
• the hemostatic composition is substantially devoid of polyanions.
• the positively-charged groups are present in the hemostatic composition at a total ionic capacity of not less than 2 mmol/g, e.g. between 2 to 5, 3 to 4mmol/g
• a ratio between the anion exchanger and the calcium in the hemostatic composition is in the range of between 1 :5 to 1 :70. In some embodiments, the ratio is about 1 :34.
• the anion exchanger is present at a concentration of 1-99% w/v of the total hemostatic composition, optionally at a concentration of 5-15% w/v of the total hemostatic composition, such as, for example, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13% 14% or 15%.
• the positively-charged groups are provided by a base selected from the group consisting of a strong base (such as one comprising quaternary amino groups), a weak base (such as one comprising an amino group selected from the group consisting of a primary amino group, a secondary amino group, a tertiary amino group and a combination thereof) and a combination thereof.
• a strong base such as one comprising quaternary amino groups
• a weak base such as one comprising an amino group selected from the group consisting of a primary amino group, a secondary amino group, a tertiary amino group and a combination thereof
• the weak base comprises Diethylaminoethyl (DEAE) groups.
• the positively-charged groups are bound to the matrix via a linker present between the matrix support and the positively charged groups.
• the matrix is selected from the group consisting of a polysaccharide, a polypeptide (such as gelatin, bovine serum albumin (BSA) or collagen, or combinations thereof), polyacrylamide, acrylate-copolymer, polystyrene-divinylbenzene, silica and a combination thereof.
• a polysaccharide such as gelatin, bovine serum albumin (BSA) or collagen, or combinations thereof
• BSA bovine serum albumin
• polyacrylamide acrylate-copolymer
• polystyrene-divinylbenzene silica and a combination thereof.
• the matrix is cross-linked, optionally covalently cross-linked.
• the matrix is devoid of ionic cross-linkages.
• the polysaccharide is selected from the group consisting of cellulose, dextran, agarose, and combinations thereof.
• the matrix comprises SEPHADEXTM (dextran),
• SEPHACELTM cellulose
• TOYOPEARLTM hydroxylated methacrylic polymer
• the composition is in a form selected from the group consisting of a slurry, powder, film, patch and liquid. According to some such embodiments, wherein the composition in the form of slurry or liquid, the composition further comprises a pharmaceutically acceptable carrier.
• the salt used herein is a positive divalent cation.
• calcium is present in the hemostatic composition as a calcium salt such as calcium chloride, calcium acetate, calcium lactate, calcium oxalate, calcium carbonate, calcium gluconate, calcium phosphate, calcium glycerophosphate or combinations thereof.
• the calcium salt is calcium chloride, optionally present as a solution, further optionally at a concentration of from 1 to 100 mM.
• calcium present in the hemostatic composition is calcium chloride.
• the hemostatic composition is substantially devoid of all proteins of the blood clotting cascade.
• the matrix is devoid of the following polyanionic polymers: alginates and/or hyaluronates.
• the matrix is devoid of one or more cross-linkable polyanionic polymer selected from the group consisting of polystyrene sulfonate (such as sodium polystyrene sulfonate), a polyacrylate (such as sodium polyacrylate), a polymethacrylate (such as sodium polymethacrylate), a polyvinyl sulphate (such as sodium polyvinyl sulphate), a polyphosphate (such as sodium polyphosphate), Iota carrageenan, Kappa carrageenan, gellan gum, carboxyl methyl cellulose, carboxyl methyl agarose, carboxyl methyl dextran, carboxyl methyl chitin, carboxyl methyl chitosan, a polymer modified with a carboxyl methyl group, an alginate (such as sodium alginate), a polymer containing a plurality of carboxylate groups, a xanthan gum, and combinations thereof.
• the polymers of the matrix are not modified by the addition of carboxymethyl (CM) groups.
• a biocompatible polymer is modified with a diethylaminoethyl (DEAE) group to gain cationic functional groups to become a polycationic polymer.
• DEAE diethylaminoethyl
• the polycationic polymer is selected from the group consisting of a chitosan (such as chitosan chloride), chitin, diethylaminoethyl-dextran, diethylaminoethyl-cellulose, diethylarninoethyl-agarose, diethylaminoethyl-alginate, a polymer modified with a diethylaminoethyl group, a polymer containing a plurality of protonated amino groups, and a polypeptide having an average residue isoelectric point above 7, and combinations thereof.
• the polycationic polymer is diethylaminoethyl- dextran (DEAE-Dextran).
• the matrix is devoid of alginic acid and of pectic acid.
• a hemostatic composition comprising Diethylaminoethyl (DEAE) bound to a matrix; and a calcium salt.
• DEAE Diethylaminoethyl
• a method for the preparation of a hemostatic composition comprising preparing an anion exchanger by covalently binding at least one positively-charged group to a cross-linked matrix; and adding a calcium salt to said anion exchanger.
• hemostatic composition obtainable by the method disclosed herein.
• the hemostatic composition is substantially devoid of all biological hemostats, i.e. devoid of all protein components of the blood clotting cascade, namely Fibrinogen, fibrin, Factor V, Factor Va, Factor VII, Factor Vila, Factor VIII, Factor Villa, Factor IX, Factor IXa, Factor X, Factor Xa, Factor XIa, Factor XI, Factor XII, Factor Xlla, tissue factor (TF), and thrombin, and prothrombinase complex, prothrombin, and vWF., tenase complex, high-molecular-weight kininogen (HMWK), Prekallikrein, kallikrein, thromboplastin.
• HMWK high-molecular-weight kininogen
• the hemostatic composition is substantially devoid of all proteins of the blood clotting cascade (such as thrombin, prothrombin and fibrinogen).
• the anion exchanger comprises a matrix (also referred to as a “support”, “backing”, “background”, “base beads” or “resin”), which may be solid or semisolid, optionally in the form of beads to which one or more positively charged group is bound.
• a matrix also referred to as a "support”, “backing”, “background”, “base beads” or “resin”
• the matrix is capable of supporting pressure as typically exerted during surgery when using adjunct materials to stop bleeding without disintegrating.
• the matrix comprises a cross-linked polymer.
• the solid or semi-solid matrix material does not dissolve or disintegrate until hemostasis is achieved (at least 1 minute from application of the hemostatic composition).
• the polymer from which the matrix is formed is insoluble in water, and is preferably porous, having an exclusion limit of at least 20K Da. According to some embodiments, the matrix does not disintegrate when subjected to manual physical compression.
• positively charged groups refers to a molecule comprising chemical groups which carries a positive charge at a pH range of 2.0 to 10 such as ammonium, alkyl ammonium, dialkylammonium, trialkyl ammonium, quaternary ammonium, diethylaminoethyl (DEAE), dimethylaminoethyl (DMAE), triethylaminoethyl, trimethylaminoethyl, alkyl groups, amino functional groups (e.g. NR 2 H + ), diethyl-(2- hydroxypropyl) aminoethyl, trimethylamino-hydroxypropyl, and a combination thereof.
• DEAE diethylaminoethyl
• DMAE dimethylaminoethyl
• amino functional groups e.g. NR 2 H +
• diethyl-(2- hydroxypropyl) aminoethyl trimethylamino-hydroxypropyl, and a combination thereof.
• the ion exchanger has multiple pKa values, ranging from 6 to 14. In a further embodiment, the ion exchanger has a single pKa value above 9.
• the anion exchanger comprises DEAE bound to any matrix known to have hemostatic properties, to increase the hemostatic efficacy of the matrix.
• suitable matrixes include, without limitation, gelatin, cellulose, collagen, and starch.
• the hemostatic composition comprises a blend of at least an anion exchanger and calcium.
• blend is intended to refer to any form of a mixture, homogenous or non-homogenous, of at least the anion exchanger and the calcium.
• the blend may optionally further include other ingredients.
• the blend is substantially free or devoid of any protein component of the blood clotting cascade (i.e. such components are present in the composition at a concentration of less than 0.1% w/w of the total composition), e.g. the blend may be substantially free or devoid of thrombin and fibrinogen.
• the blend is a slurry, powder or liquid blend.
• the blend is provided in a frozen state, such that prior to use, the product is thawed and brought to room temperature (i.e. in the range of 15- 40°C), wherein the blend is in its usable state.
• the composition disclosed herein stops bleeding of a wound within 1 minute.
• hemostatic composition refers to a material or composition which functions by causing blood to clot i.e. induces hemostasis. Typically, a hemostat increases blood coagulation.
• inces hemostasis with regard to a composition refers to a composition which causes blood to clot by activation of clotting factors, such as prothrombin, resulting in cessation of bleeding or reduction of bleeding intensity.
• stops bleeding or “cessation of bleeding” with regard to a composition refers to a composition which, when applied to the site of a wound, results in no bleeding e.g. on a scale of 0 (no bleeding) to 5 as described in the MATERIALS AND METHODS section below.
• the term “reduction in bleeding intensity” refers to the difference between the Initial Bleeding Intensity and the Post- Application Bleeding Intensity.
• Initial Bleeding Intensity refers to the intensity of bleeding as evaluated immediately following formation of a wound and prior to application of a composition, e.g. on a scale of 0 to 5 as described in the MATERIALS AND METHODS section below.
• Post- Application Bleeding Intensity for a specified compression time refers to the intensity of bleeding as evaluated following application of a composition and after the compression time e.g. on a scale of 0 to 5 as described in the MATERIALS AND METHODS section below.
• the hemostatic efficacy of the composition can be evaluated in terms of the compression time when applied to a bleeding wound.
• compression time refers to the time for which manual compression is applied to a bleeding wound following application of a composition. Typically, this force equals the strength usually exerted by a surgeon upon usage of adjunct products to achieve hemostasis. In some embodiments, wherein no compression is applied, the compression time is referred to as 0 seconds.
• the compression time is about 8 to 12 minutes. In some embodiments, in problematic bleeding, the compression time is about 5 minutes. In some embodiments, in bleeding encountered in a general surgical procedure, the compression time is about 1 to 2 minutes.
• "Problematic bleeding" is defined as Class III hemorrhage and above according to WHO Classification. Typically, Class III Hemorrhage involves loss of 30-40% of circulating blood volume. Typical symptoms include: a drop in the patient's blood pressure, increase of heart rate, peripheral hypoperfusion (shock).
• thrombin is generated in-situ. Surprisingly, this in-situ thrombin generation was found to occur to a sufficient extent and with sufficient speed to achieve hemostasis.
• the presence of a physical matrix enables the hemostatic composition to be easily applied to the site of bleeding, optionally with compression.
• the matrix itself may contribute to coagulation by entrapping platelets, similar to oxidized regenerated cellulose (ORC).
• a matrix is a prerequisite for the hemostatic capabilities of a positively charged functional group such as DEAE.
• the matrix has to be of such a nature that it does not dissolve upon initial contact with liquids and maintains its integrity until hemostasis is achieved, for example, for at least 1 minute, and allows the aggregation of blood proteins to concentrate locally at the wound site thus allowing initiation of the coagulation cascade.
• the matrix is stable under pressure usually exerted by a surgeon during general surgery to achieve hemostasis.
• the nature of the matrix is such that it distributes on and/or within the wound following application, optionally with the use of compression.
• compositions substantially lead to complete hemostasis regardless of the specific matrix used. It was also found that a composition comprising an anion exchanger, such as DEAE bound to a matrix, such as SEPHADEXTM, SEPHACELTM and TOYOPEARLTM (dextran, cellulose and hydroxylated methacrylic polymer, respectively) together with a calcium salt, lead to complete hemostasis.
• an anion exchanger such as DEAE bound to a matrix
• SEPHADEXTM SEPHACELTM
• TOYOPEARLTM extran, cellulose and hydroxylated methacrylic polymer, respectively
• DEAE Sephadex in CaCl 2 was able to cease bleeding after 60, and 30 seconds of compression.
• DEAE SEPHADEXTM A-50 (8% w/v) application could be used, without compression, to reduce bleeding intensity.
• the hemostatic capabilities of a composition comprising DEAE Sephadex (such as DEAE SEPHADEXTM A-50) and a calcium salt were found to exhibit similar efficacy to that of commercial gelatin hemostat with thrombin, e.g. when using the same compression time (such as 30 seconds or 10 seconds of compression).
• the hemostatic capability of a hemostat based on an anion exchanger comprising DEAE bound to a matrix, and a calcium salt was substantially superior to that of commercial gelatin hemostat in the absence of a biologically active component, such as thrombin.
• Time to hemostasis (TTH) of normal plasma in the presence of calcium is about 200 seconds.
• TTH of normal plasma in the presence of calcium and an anion exchanger is in the range of about 10 to 180 seconds, such as in the range of about 10 to 60 seconds, in the range of about 10 to 30 seconds, in the range of about 15 to 60 seconds, in the range of about 15 to 30 seconds, and in the range of about 30 to 60 seconds.
• the TTH is about 30 seconds.
• an anion exchanger such as DEAE bound to a matrix together with a calcium salt provided complete hemostasis. This result was obtained regardless of the matrix used. The results are comparable to those obtained when using a commercial hemostat such as gelatin together with thrombin. It was found that QAE SEPHADEXTM together with a calcium salt reduced bleeding. A composition devoid of a calcium salt and/or a matrix had no effect on the bleeding intensity.
• DEAE bound to a cross-linked matrix according to the invention was successful in achieving complete hemostasis in-vivo in heparinized porcine spleen circular punch model while DEAE not bound to a matrix failed to decrease the bleeding intensity.
• the density (i.e. presence) of positively charged groups which are bound to a matrix as disclosed herein are shown to be of importance in order to achieve hemostasis. Charges on a matrix may advantageously be present at a density which is sufficient to achieve hemostasis according to the invention.
• the synthesized matrix can be monomerized, such as by acid hydrolysis, and applied to an analytical instrument (e.g. High-Pressure Liquid Chromatography, Gas Chromatography), capable of separating the monomers based on the different charges they carry. This way an analysis can be performed to evaluate the charge density on a certain molecule.
• an analytical instrument e.g. High-Pressure Liquid Chromatography, Gas Chromatography
• the model was based on a model previously described in WO 2012087774 Al, with some modifications. This model evaluates the efficacy of a tested composition in reducing bleeding in-vivo (hemostatic efficacy). Initially, the organ in which hemostasis was to be studied was exposed and then subjected to a single biopsy punch (4 mm diameter, 2 mm depth in Example 1 and 5; 4 mm diameter, 2 mm depth or 8 mm diameter, 3 mm depth in Example 2, second experiment). The tissue in the punch was removed.
• the Initial Bleeding Intensity was rated ("initial bleeding") on a scale from 0 to 5 wherein: 0 - "No Bleeding”; 1- "Oozing”; 2- “Very Mild Bleeding”; 3- “Mild Bleeding”; 4- "Moderate Bleeding”; 5-"Severe Bleeding".
• compositions that were applied as powder were applied into the bleeding punch wound.
• Compositions that were applied as a slurry were applied into the wound using a syringe; compositions that were applied as a powder were applied directly onto the wound.
• compression time also referred to herein as “compression time”
• gauze was removed and Post-Application Bleeding Intensity was evaluated immediately and after a further 1 minute, either qualitatively (yes/no) or quantitatively (using the scale from 0 to 5 as described above).
• a tested composition which reduced the bleeding intensity (which started at least at 3) to 1 (Oozing) or 0 (No Bleeding) was considered effective.
• the presence or absence of bleeding was examined visually as well as with a piece of gauze pressed onto the rim of the treated area.
• the heparinized biopsy punch model is considered to be a suitable model for evaluating strong hemostasis.
• Time to Hemostasis was evaluated following application of the composition.
• Time to Hemostasis was evaluated following application of the composition.
• TTH is defined as the time interval from application of the composition until complete hemostasis (score 0) was observed.
• Example 1 The hemostatic properties of a composition comprising an anion exchanger and a calcium salt in an in-vivo spleen model.
• DEAE SEPHADEXTM A-50 prepared as 10% w/v slurry in 20 m CaCl 2 solution, (0.5 ml contains 50 mg DEAE SEPHADEXTM A-50) (30 seconds compression time);
• DEAE SEPHADEXTM A-50 prepared as 6.6% w/v slurry in 20 mM CaCl 2 solution, (0.5 ml contains 33 mg DEAE SEPHADEXTM A-50) (60 seconds compression time);
• SEPHADEXTM G-75 Superfine prepared as 10% w/v slurry in 20 mM CaCl 2 solution, (0.5 ml contains 50 mg per SEPHADEXTM G-75 Superfine) (60 seconds compression time);
• SEPHADEXTM G-50 Medium prepared as 10% w/v slurry in 20 mM CaCl 2 solution, (0.5 ml contains 50 mg SEPHADEXTM G-50 Medium) (60 seconds compression time);
• compositions 1-4 were provided as powders, from which slurries were prepared as described in the Table 1 above. A commercial gelatin flowable hemostat was used as control.
• SEPHADEXTM G-50 Medium failed to stop the bleeding, i.e. no reduction in bleeding intensity was observed (results not shown).
• DEAE SEPHADEXTM A-50 reduced the bleeding at all tested compression times.
• the spleen was manually manipulated by folding the organ from both sides. No re-bleeding occurred at either of the tested concentrations and following the two different compression times (results not shown). Since hemostasis only occurred in the matrix supplemented with DEAE groups it was concluded that the hemostatic effect was due the presence of the DEAE groups.
• Fig. 1 shows an exemplary result obtained using DEAE SEPHADEXTM A-50 10% (w/v) and commercial gelatin. As shown in the figure, commercial gelatin hemostat failed to stop the bleeding after a compression time of 60 seconds, whereas DEAE SEPHADEXTM A- 50 10% (w/v) successfully stopped the bleeding even following a shorter compression time of 30 seconds.
• Example 2 Effect of compositions comprising an anion exchanger and calcium on hemostasis in an in-vivo porcine liver model.
• compositions were evaluated:
• DEAE SEPHADEXTM A-50 prepared as 8% w/v slurry in 20 mM CaCl 2 solution (0.5 ml contains 40 mg DEAE SEPHADEXTM A-50);
• SEPHADEXTM G-50 Medium prepared as 14% w/v slurry in 20 mM CaCl 2 solution (0.5 ml contains 70 mg SEPHADEXTM G-50 Medium).
• DEAE SEPHADEXTM A-50 prepared as 8% w/v slurry in 20 mM NaCl solution (0.5 ml contains 40 mg DEAE SEPHADEXTM A-50);
• SP SEPHADEXTM C-50 prepared as 8% w/v slurry in 20 mM CaCl 2 solution (0.5 ml contains 40 mg SP SEPHADEXTM C-50);
• QAE SEPHADEXTM prepared as 8% w/v slurry in 20 mM CaCl 2 solution (0.5 ml contains 40 mg QAE SEPHADEXTM); 8. DEAE SEPHACELTM, prepared as a slurry (100 mg); and
• Bleeding Intensity Reduction was calculated by subtracting the Post- Application Bleeding Intensity from the Initial Bleeding Intensity.
• compositions comprising an anion exchanger, such as DEAE bound to a matrix, together with a calcium salt, lead to complete hemostasis (see Table 2 for DEAE SEPHADEXTM A-50, DEAE SEPHACELTM, and TOYOPEARL DEAE- 650MTM, all containing a calcium salt).
• an anion exchanger such as DEAE bound to a matrix
• TOYOPEARL DEAE- 650MTM all containing a calcium salt
• DEAE SEPHADEXTM A-50 8% w/v in CaCl 2 was able cease bleeding after 60, and 30 seconds of compression.
• the results also showed DEAE SEPHADEXTM A-50 (8% w/v) application could be used, without compression, to reduce bleeding intensity (Table 2).
• the hemostatic capabilities of a composition comprising DEAE SEPHADEXTM A-50 and a calcium salt exhibited similar efficacy to that of commercial gelatin hemostat with thrombin, when using the same compression time (30 seconds), and even with only 10 seconds of compression.
• the hemostatic capability of a hemostat based on an anion exchanger comprising DEAE bound to a matrix, and a calcium salt was substantially superior to that of commercial gelatin hemostat in the absence of a biologically active component, such as thrombin.
• SP SEPHADEXTM containing an anionic group, sulfopropyl (SP) with a calcium salt, did not reduce the bleeding intensity.
• SP sulfopropyl
• a material with a negative (SP) group, instead of a positive (DEAE) group was not effective as a hemostat.
• SEPHADEXTM A-50 (8% w/v) application resulted in complete hemostasis and therefore the TTH was defined as 30 seconds.
• a composition devoid of a calcium salt and/or a matrix had no effect on the bleeding intensity.
• composition comprising an anion exchanger and a calcium salt is effective as a hemostat.
• Example 3 Effect of compositions comprising an anion exchanger and a calcium salt on hemostasis in an in-vivo porcine spleen model.
• composition comprising an anion exchanger consisting of DEAE bound to a cross-linked polymer, and a calcium salt, was effective in reducing the bleeding intensity in an in-vivo spleen circular punch model.
• DEAE SEPHADEXTM A-50 prepared as 8% w/v slurry in 20 mM CaCl 2 solution (0.5 ml contains 40 mg DEAE SEPHADEXTM A-50);
• DEAE SEPHADEXTM A-50 prepared as 10% w/v slurry in 20 mM CaCl 2 solution (0.5 ml contains 50 mg DEAE SEPHADEXTM A-50), tested in duplicate;
• SEPHADEXTM G-50 Medium prepared as 14% w/v slurry in 20 mM CaCl 2 solution (0.5 ml contains 70 mg SEPHADEXTM G-50 Medium);
• DEAE SEPHADEXTM A-50 prepared as 8% w/v slurry in 20 mM NaCl solution (0.5 ml contains 40 mg DEAE SEPHADEXTM A-50);
• DEAE SEPHADEXTM A-50 8% and 10% w/v in the presence of CaCl 2 were able to reduce the bleeding intensity (a reduction of about 2-3 points was observed), with the higher percentage providing better results.
• the hemostatic capabilities of DEAE SEPHADEXTM A-50 were superior to those of the commercial gelatin based hemostat with or without thrombin.
• Example 4 The hemostatic properties of a solution comprising an anion exchanger and a calcium salt in an in-vivo Porcine Spleen Problematic Bleeding Model.
• DEAE SEPHADEXTM A-50 was prepared as 10% w/v slurry in a 25 mM CaCl 2 solution.
• a punch was performed using a dedicated device (see Fig. 2a), resulting in an X shaped wound, where each arm is 5.5 cm long and the center hole is 1.5 cm deep, bullet shaped and 9.5 mm in diameter (Fig. 2b).
• the wound represented a problematic bleeding (such as bullet injury).
• DEAE Dextran 500 is a polycatonic derivative of Dextran, prepared from dextran of average molecular weight of 500 kD, in which the dextran chains are not cross-linked.
• compositions were evaluated:
• DEAE SEPHADEXTM A-50 prepared as 10% w/v slurry in 20 mM CaCl 2 solution
• DEAE dextran 500 prepared with 10% (w/w) CaCk powder (100 mg powder contained 90 mg DEAE dextran and 10 mg CaCl 2 ).
• the density (i.e. presence) of positively charged groups which are bound to a matrix as disclosed herein are shown to be of importance in order to achieve hemostasis. Charges on a matrix should advantageously be present at a density which is sufficient to achieve hemostasis as defined above.
• the synthesized matrix is monomerized, such as by acid hydrolysis, and applied to an analytical instrument (e.g. High-Pressure Liquid Chromatography, Gas Chromatography), capable of separating the monomers based on the different charges they carry. This way an analysis is performed to evaluate the charge density on a certain molecule.
• an analytical instrument e.g. High-Pressure Liquid Chromatography, Gas Chromatography

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