Background: Significant intraoperative and postoperative blood loss are rare but possibly life-threatening complications after lung resection surgery either during open or minimally invasive procedure. Microporous Polysaccharide Hemospheres (ARISTA™AH) have demonstrated time-efficient haemostasis, lower post-operative blood volumes and a lower blood transfusion requirement, without any identified adverse events across other specialities.The primary aim of our study was to evaluate the impact of haemostatic agents on short-term postoperative outcomes in thoracic surgery. Methods: We retrospectively reviewed a prospectively collected database of consecutive early-stage lung cancer patients surgically treated in two European centres(October 2020-December 2022).Exclusion criteria:open surgery,patients with coagulopathy/anticoagulant medication,major intraoperative bleeding,non-anatomical lung resection and age <18 years.The cohort was divided into 5 groups according to the haemostatic agent used.Propensity score matching was used to estimate the effect of ARISTA™AH on various intra- and post-operative parameters(continuous and binary outcome modelling). Results:482 patients(M/F:223/259; VATS 97/RATS 385)with a mean age of 68.9(±10.6)years were analysed.In 253 cases ARISTA™AH was intraoperatively used to control bleeding.This cohort of patients had a significant reduction in total drain volume by 135 mls(standard error 53.9; p=0.012).The use of ARISTA™AH did reduce the average length of hospital stay(-1.47 days)and duration of chest drainage(-0.596 days)albeit not significant.In the ARISTA™AH group,we observed no postoperative bleeding,no blood transfusion required,no 30-day mortality and no requirement for redo-surgery.The use of ARISTA™AH significantly reduced the odds of post-operative complications,need for transfusion and redo surgery. Conclusion: Our data showed that Microporous Polysaccharide Hemospheres are a safe and effective haemostatic device.Its use has a positive effect in short term postoperative outcomes of patients surgically treated for early-stage lung cancer.

Background: After the outbreak of a novel coronavirus (i.e. SARS COV2) in China and its diffusion around the world, great attentions was reserved to the increased incidence of venous thromboembolism in these patients. A specific antiviral action of heparins toward SARS COV2 has been reported in vitro such as a well know action of heparins to prevent VTE in inpatients with infective disease has already been reported since several years. Yet, because fondaparinux represent the pharmacological antithrombotic active sequence of all heparins and because its clinical indication o prevent VTE in inpatients is similar to heprains, we realized a retrospective analysis in inpatients with SARS COV2 on the incidence of VTE during pharmacological prophylaxis with enoxaparin or fondaparinux. This retrospective analysis was named FONDENOXAVID. Methods: We conducted a retrospective cohort study that used patients with SARS COV2 during the Italian outbreak from February 18, 2020 to April 30, 2020. Our aim was to compare the clinical characteristics, prophylactic treatment and outcomes in inpatients positive to SARS COV2 at risk to develop venous thromboembolism, in particular venous thrombosis with or without pulmonary embolism, during in-hospital primary thromboprophylaxis with enoxaparin (40 mg or 60 mg once daily) or fondaparinux (2.5 mg once daily). Statistical analysis was conducted with using MatLab R2016B and eventually ad hoc functions. Results: There were not significative differences in clinical characteristics between patients that used enoxaparin or fondaparinux as thromboprpophylaxis for SARS COV2. The cumulative incidence of thrombotic events was not different in patients that used enoxaparin or fondaparinux as thromboprpophylaxis. No differences were found also in d-dimer and fibrinogen levels test at the admission and after 3 weeks as markers of prolonged inflammation due to SARS COV2. Discussion: The increased incidence of VTE in vivo has been reported in several studies although prophylaxis with low molecular weight heparin was conducted in some of them. The clinical indication to prevent VTE was similar for heparins and fondaparinux. In our results a non-inferiority to prevent VTE was recorded when inpatients with SARS COV2 were treated with prophylactic doses of enoxaparin or fondaparinux according to international guidelines. The incidence of VTE in this retrospective analysis showed that Fondaparinux at fixed doses of 2.5 mg daily was not inferior to enoxaparin (4000 UI daily). Our results testify that fondaparinux and enoxaparin showed the same efficacy to reduce the incidence of VTE in inpatients with SARS COV2.