Review of Evidence Supporting the Arista™ Absorbable Powder Hemostat

Figures & data

Table 1 Characteristics of Mechanical Hemostats Approved for Use in the US

Characteristic	MPH	ORC	Microfibrillar Collagen	Gelatin Matrix
Brand name	Arista™ AH	Surgicel^®	Avitene™	Gelfoam^® Surgifoam^®
Available forms	Powder	Woven mesh or powder	Sponge or powder	Sponge or powder
Source	Plant		Bovine	Porcine
Mechanism of action	Absorbs water, concentrates platelets and blood proteins	Activates extrinsic coagulation cascade; provides scaffold for platelet aggregation and clot formation		Absorbs blood and fluid, matrix for clot formation, mechanical barrier
Absorption time	48 hours	1–2 weeks^a	8–12 weeks	4–6 weeks
Storage	Room temperature
Preparation before use	Not required
Compatibility with autologous cell salvage machines	Yes	No
Potential adverse events	None reported	Infection, abscess, foreign body reaction, granuloma formation	Infection, abscess, foreign body reaction, granuloma formation Systemic allergic reactions	Infection, abscess, foreign body reaction, granuloma formation
Other Considerations	Caution with use >50g in diabetic patients, as it may alter glucose level	Not to be used with topical thrombin Low pH has antimicrobial effect	None	Should not be placed in tight spaces due to risk of compression necrosis Can be moistened with thrombin

Notes: ^aThere are rare reports of persistent material up to 15 months postoperatively. Vyas and Saha¹⁷

Abbreviations: AH, absorbable hemostat; MPH, microporous polysaccharide hemospheres; ORC, oxidized regenerative cellulose.

Table 2 Summary of Preclinical Studies of Arista™ AH

Reference	Study Objective/Surgery Type/Animal Model	Experimental Groups	Key Results
Single-arm studies of Arista™ AH
Murat et al (2006)^Citation42	Evaluate the efficacy of Arista™ AH for parenchymal hemostasis during laparoscopic partial nephrectomy in the porcine model Laparoscopic partial nephrectomy	Arista™ AH	Hemostasis was achieved after one Arista™ AH application in 8/12 kidneys In 3 kidneys, a small amount of Arista™ AH (1 g) was required for minor residual bleeding In 1 kidney, an additional 2.0 g of Arista™ AH was required After one week, no residual Arista™ AH was found In 2/6 chronic phase kidneys, small urinomas (<2 cm in greatest diameter) were found at necropsy; these were the only post-operative complications
Humphreys et al (2008^a)^Citation43	Evaluate Arista™ AH in intracorporeal laparoscopic splenic injury Pigs	Arista™ AH	Arista™ AH successfully achieved hemostasis for all splenic injuries except in 1 case, where a 12-mm lesion transected the splenic artery Mean time to hemostasis (s):- 5-mm injuries: 165.3 ± 45.7- 12-mm injuries: 200.7 ± 106.5 Number of Arista™ AH applications: 1.3 ± 0.5 in both groups Estimated blood loss (g):- 5-mm injuries: 12.0 ± 4.6- 12-mm injuries: 17.7 ± 9.1
Studies comparing Arista™ AH to control
Benlier et al (2007)^Citation63	Evaluate the effects of Arista™ AH on tissue toxicity/vessel damage, patency rates, and anastomotic time in vascular anastomosis Vascular surgery Rats	Arista™ AH Control: conventional interrupted suture technique	Duration of clamping was significantly shorter in the Arista™ AH than in the control group (P < 0.001) All the vessels were patent at 1 hr and 24 hrs after the release of clamps Thrombus formation was observed in two vessels on Day 28 in the control group, but the difference was not significant between groups The Arista™ AH group showed qualitatively less perivascular foreign-body giant cell reactions than the control group There was no evidence of vascular mural fibrinoid necrosis, indicating that Arista™ AH was nontoxic to the vessel walls
Humphreys et al (2008^b)^Citation37	Determine the effectiveness of Arista™ AH in the intracorporeal laparoscopic environment for trocar injury to the renal parenchyma Laparoscopic renal surgery Pigs	Arista™ AH Control: compression	Mean time to hemostasis was significantly shorter in the Arista™ AH than in the control group for both 5 mm and 12 mm lesions (P = 0.005) Mean number of Arista applications:- 5-mm lesions: 1.0 ± 0.0- 12-mm lesions: 1.7 ± 0.5 Mean blood loss until hemorrhage stopped was not different between the Arista™ AH and control groups
Egeli et al (2012)^Citation64	Investigate the effects of Arista™ AH on lymphovascular drainage and delay in wound healing, which may lead to seroma formation Mastectomy Rats	Arista™ AH No hemostat	Mean seroma volume was significantly lower in the Arista™ group than in the control group (P = 0.001) Increase in fibrous tissue was greater in the control than in the Arista™ AH group (P = 0.032) Mean albumin and LDH levels, and WBC count were significantly higher in the control group (P = 0.03 for all parameters)
Offodile et al (2017)^Citation18	Evaluate the effect of Arista™ AH on tissue survival Skin flap Rats	Arista™ AH No hemostat	Arista™ AH group had a significantly larger mean area of necrosis at the distal flap than the control group

Abbreviations: AH, absorbable hemostat; LDH, lactate dehydrogenase; WBC, white blood cells.

Table 3 Comparative Animal Studies of Arista™ AH versus Surgicel^®

Reference	Study Objective/Surgery Type/Animal Model	Experimental Groups	Key Results
Studies comparing Arista™ AH to Surgicel^® and other plant-based topical hemostats
Hoffmann et al (2009)^Citation66	Examine the impact of Arista and Surgicel^® on intraperitoneal and cecal adhesion formation Abdominal surgery Rats	Arista™ AH Surgicel^® Control: no treatment	Mean total adhesion score was significantly lower with Arista™ AH and Surgicel^® compared with control (P < 0.05 for both comparisons) Only Arista™ AH was completely resorbed on day 7 in all animals
Emmez et al (2010)^Citation67	Compare the effectiveness and safety of Surgicel^® and Arista™ AH Neurosurgery Rats	Arista™ AH Surgicel^® Control: cotton irrigated with isotonic saline	There were no significant differences in hemorrhage, inflammation, pericellular edema, or neuronal degeneration between groups Hemostatic agent was visible in all specimens in the Surgicel^® group, but not in the Arista™ AH or control groups MRI revealed no significant differences in edema volume between Arista™ AH and Surgicel^® groups Edema volume was significantly larger in the control group compared to Arista™ AH or Surgicel^® groups (P < 0.001)
Ereth et al (2008^a)^Citation65	Compare the safety and efficacy of commonly used agents with Arista in a neurosurgical model Neurosurgery Rats	Arista™ AH Surgicel^® Control: no hemostat	Complete hemostasis was achieved after 1 min in the majority of lesions treated with a hemostatic agent All rats in the Surgicel^® group had residual material upon examination None of the rats with Arista™ AH had any residue as early as 6 hours after application The amount of residual material was significantly greater with Surgicel^® compared with Arista™ on Days 3 and 7 (P < 0.001) Arista™ AH was the only agent that was not associated with inflammation (granuloma) at any time point after surgery
MacDonald et al (2017)^Citation19	Compare the efficacy of powder hemostats Liver punch biopsy and liver abrasion Pigs	Arista™ AH Surgicel^® absorbable powder PerClot^®b	Effective hemostasis was achieved in all cases in the Arista™ AH and Surgicel^® groups The proportion of cases that achieved effective hemostasis was significantly higher with Arista™ AH and Surgicel^® than with PerClot^® Hemostatic efficacy (ie, complete hemostasis achieved within 10 minutes) was significantly better with Surgicel^® than with Arista™ AH or PerClot^® Time to hemostasis was significantly shorter with Surgicel^® than with Arista™ or PerClot^®
Studies comparing Arista™ AH to animal-based hemostats
Singh et al (2019)^Citation41	Compare bovine-derived gelatin hemostatic powder to Arista™ AH Sinus surgery Pigs	Arista™ AH Bovine-derived gelatin	Immediate hemostatic success (ie, hemostasis within 2 minutes of application) was achieved in 88% of gelatin-treated lesions and 65% of Arista™ AH -treated lesions Gelatin powder achieved significantly greater hemostatic success compared with Arista™ AH (OR 15.18; 95% CI 7.37–31.27; P < 0.001)
Ereth et al (2009)^Citation68	Determine if the use of Arista™ AH in abdominal surgical incisions reduces infection Abdominal surgery Rats	Arista™ AH Gelatin matrix (Gelfoam^®) Control: no hemostat	The gelatin matrix group had greater median bacterial count in the incisions and more clinical infections than the control and Arista groups (P < 0.0001) at 72 hrs. after E. coli instillation There were no differences in bacterial count between the Arista™ AH and control groups
Antisdel et al (2008)^Citation69	Evaluate the effects of Arista™ AH on healing and intact sinus mucosa Sinus surgery Rabbits	Arista™ AH FloSeal^®	In Arista™ AH-treated sinuses, the epithelium in the mucosa-intact rabbits was not different from untreated intact rabbit maxillary sinus mucosa No foreign material or foreign body reaction was noted FloSeal^® treated stripped mucosa showed disrupted and disorganized epithelial regrowth with sparse cilia, with foreign body material on both sides of the epithelium In FloSeal^®-treated mucosa-of intact sinuses, abnormal and metaplastic epithelium with a large decrease of cilia was observed Moderate submucosal fibrosis with loss of serous glands, osteoneogenesis, and chronic inflammation of the lamina propria Residual FloSeal^® was observed intraluminally
Ereth et al (2008^b)^Citation70	Evaluate the effects of Arista™ AH and other hemostatic agents on bone healing and regeneration Cranial surgery Rabbits	Arista™ AH Microfibrillar collagen Bone wax Control: no hemostat	Bone healing score was significantly higher with Arista™ AH than with microfibrillar collagen (P < 0.05); there were no significant differences between Arista™ AH, control, and bone wax Histomorphometry analysis showed that at 7 weeks, 2 defects in the control group and 1 in Arista™ AH group were completely healed, whereas no defect in the microfibrillar collagen or bone wax groups healed completely

Notes: ^aOther agents were also evaluated in the study, however, data are only presented for hemostatic agents available in the US. ^bPerClot^® is expected to be approved in the US in 2023.

Abbreviations: AH, absorbable hemostat; CI, confidence interval; MRI, magnetic resonance imaging; OR, odds ratio.

Table 4 Single-Arm Clinical Studies of Arista™ AH

Reference	Study Design (N)	Surgery Type	Key Results
Bruckner and Loebe (2012^a)^Citation48	Case study N = 2	Cardiac	Surgical field bleeding improved after application of Arista™ AH
Bruckner and Loebe (2012^b)^Citation49	Case study N = 1	Cardiac	Arista™ AH provided effective local control of diffuse bleeding
Galarza et al (2011)^Citation52	Case series N = 10	Cranial	Effective hemostasis was achieved in ≤2 min after Arista™ AH application in 8/10 patients There were no allergic reactions or systemic complications There were no cases of cerebral hematoma, swelling, or infection
Phillips (2013)^Citation51	Prospective, observational N = 155	Sinus	Arista™ AH was well-tolerated and no allergic reactions were observed None of the patients required secondary intervention for obstructive synechiae Nursing personnel noted improvements in patient satisfaction and reduced postoperative bleeding
Sindwani (2009)^Citation50	Prospective, observational N = 65	Sinus	Hemostasis was obtained in ~30–45 s after Arista™ AH application There was no significant postoperative bleeding that required an ER visit, hospital admission, or nasal packing or cautery No Arista^TM AH was detected in any of the sinus cavities at the one-week debridement Synechiae formation was noted in 8/65 of patients; only 2 were grade 2 and required lysis

Abbreviations: AH, absorbable hemostat; ER, emergency room.

Table 5 Comparative Clinical Studies of Arista™ AH

Reference	Study Design; N; Comparators	Surgery Type	Key Results
Studies comparing Arista™ AH to untreated control
Bruckner et al (2014)^Citation2	Retrospective; N = 240 n = 103 Arista™ AH n = 137 Control Control patients received another hemostatic agent (FloSeal^®, Gelfoam^® with thrombin, or Surgicel^®)	Cardiothoracic	Hemostasis time was significantly shorter in the Arista™ AH than in the control group (P = 0.02) Arista™ AH significantly reduced postoperative chest tube output in the first 48 hrs. (<0.001), and the red blood cell transfusion volume (P < 0.001) The length of ICU stay was numerically lower in the Arista™ AH (8 days) than in the control group (9 days; P = 0.08) There were no significant differences in 30-day mortality or postoperative complications between the groups
Reynbakh et al (2018)^Citation53	Retrospective N = 283 n = 77 Arista™ AH n = 206 Control Method of hemostasis in the control group not specified	Cardiac	Arista™ AH was associated with a significantly lower complication rate compared to control (P < 0.05) The rate of hematoma was lower in the Arista™ AH (0.4%) than in the control (0.8%) group The rate of infection was lower in the Arista™ AH (0%) than in the control (3.4%) group
Antisdel et al (2009)^Citation54	Randomized, controlled, single-blinded n = 40 Arista™ AH n = 40 Untreated control Contralateral side served as a non-treated control	Sinus	Bleeding score on post-operative day 1 was significantly lower in the Arista™ AH than in the control group (P < 0.0001) Patient-reported scores for bleeding were not significantly different between the groups (P > 0.05) There were no significant differences in pain, obstruction, or nasal discharge between Arista™ AH-treated and control sides
Antisdel et al (2011)^Citation55	Randomized, controlled, double-blind n = 40 Arista™ AH n = 40 Control Contralateral side served as a non-treated control	Sinus	There was no significant difference in synechiae formation, or the frequency or degree of debridement between the Arista™-treated and control sides No residual material was noted on either the Arista™ AH-treated or control sides The presence and degree of infection and extent of edema were similar between the two groups
Suarez-Kelly et al (2019)^Citation36	Prospective, randomized, single-blinded N = 42 n = 21 Arista™ AH n = 21 Untreated	General (mastectomy)	There were no significant differences between Arista™ AH and control groups in mean time until drain removal, drain output, number of clinic visits, or postoperative complications
Nunez-Nateras et al (2013)^Citation56	Retrospective N = 30 n = 10 Arista™ AH n = 20 Control Method of hemostasis for the control group was not specified	Prostatectomy	The change in hemoglobin after 24 hrs. was lower in the Arista™ AH group, but the difference was not statistically significant 2 patients in the control group had urinary extravasation that required prolonged catheterization There were no significant differences between groups in prostate size, post-operative Gleason sum, negative margins, proportion of patients requiring transfusion, or duration of catheterization OR time was shorter in the Arista™ AH group, but was not sig. diff. (P = 0.038)
Gilbert et al (2016)^Citation57	Prospective randomized N = 88 n = 88 Arista™ AH n = 88 Untreated control (contralateral side)	Prostatectomy with pelvic lymph node dissection	Fewer lymphoceles were found on the Arista™ AH-treated side (5.7%) than the control side (10.2%), although the difference was not statistically significant
Gleason et al (2019)^Citation58	Case-control retrospective chart review N = 147 n = 93 Arista™ AH n = 54 Untreated control	Orthopedic	There were no differences in the rate of superficial infections or hematomas between the groups Expected surgical blood loss was significantly higher in the Arista™ AH group (P = 0.0004) There were no significant differences in the reduction in hemoglobin levels between pre-operative levels and post-operative Day 2 between the Arista™ AH and control groups (P = 0.604) There were no differences in transfusion rates between the groups (P = 0.844)
Studies comparing Arista™ AH to other hemostats
Bard Davol Inc (2015)^Citation39	Prospective, multi-center, randomized, non-inferiority, controlled N = 288 n = 145 Arista™ AH n = 143 absorbable gelatin sponge with or without Thrombin	General Orthopedic Cardiac	Complete hemostasis within 5 min (3 min for cardiac surgery):- Arista™ AH: 90.3%- Gelatin sponge: 80.4%- P < 0.0001 Complete hemostasis in 1 min:- Arista™ AH: 50.3%- Gelatin sponge: 32.9% Complete hemostasis in 3 min:- Arista™ AH: 85.5%- Gelatin sponge: 72.0% P = 0.003 (overall time to hemostasis) Time to hemostasis, median (min)- Arista™ AH: 1.0- Gelatin sponge: 2.0- P = 0.002
Palacios et al (2013)^Citation59	Retrospective N = 23 n = 12 Arista™ AH n = 11 FloSeal^® (contralateral side)	Renal	There were no significant differences between Arista™ AH and FloSeal^® in the cool ischemia time, intra-operative blood loss, duration of hospital stay, or postoperative complications
Antisdel et al (2016)^Citation60	Prospective, double-blind N = 48 n per group not reported Arista™ AH Sinufoam™ (CMC foam/gel) Nexfoam^® (starch wafer)	Sinus	There were no significant differences between groups in patient-reported symptoms There were no significant differences in synechiae formation, debridement requirement, mucosal edema, or infection between the groups There was more crusting and granulation the Sinufoam™ group, although the difference was not statistically significant

Abbreviations: AH, absorbable hemostat; CMC, carboxymethyl cellulose; ICU, intensive care unit; MPH, microporous polysaccharide hemospheres.

Vyas KS, Saha SP. Comparison of hemostatic agents used in vascular surgery. Expert Opin Biol Ther. 2013;13(12):1663–1672. doi:10.1517/14712598.2013.848193

 PubMed Web of Science ®Google Scholar

Murat FJ, Le CQ, Ereth MH, et al. Evaluation of microporous polysaccharide hemospheres for parenchymal hemostasis during laparoscopic partial nephrectomy in the porcine model. JSLS. 2006;10(3):302–306.

 PubMedGoogle Scholar

Humphreys MR, Castle EP, Andrews PE, et al. Microporous polysaccharide hemospheres for management of laparoscopic trocar injury to the spleen. Am J Surg. 2008;195(1):99–103. doi:10.1016/j.amjsurg.2007.03.006

 PubMed Web of Science ®Google Scholar

Benlier E, Top H, Aygit AC, et al. Microvascular anastomosis with minimal suture and arista: an experimental study. J Reconstruct Microsurg. 2007;23(6):311–315. doi:10.1055/s-2007-985213

 PubMed Web of Science ®Google Scholar

Humphreys MR, Lingeman JE, Terry C, et al. Renal injury and the application of polysaccharide hemospheres: a laparoscopic experimental model. J Endourol. 2008;22(6):1375–1381. doi:10.1089/end.2008.0008

 PubMed Web of Science ®Google Scholar

Egeli T, Sevinc AI, Bora S, et al. Microporous polysaccharide hemospheres and seroma formation after mastectomy and axillary dissection in rats. Balkan Med J. 2012;29(2):179–183. doi:10.5152/balkanmedj.2012.005

 PubMed Web of Science ®Google Scholar

Offodile AC, Chen B, Aherrera AS, et al. Microporous polysaccharide hemospheres potentiate ischemia-induced skin flap necrosis in a murine model. Plast Reconstr Surg. 2017;139(1):59e–66e. doi:10.1097/PRS.0000000000002907

 PubMed Web of Science ®Google Scholar

Hoffmann NE, Siddiqui SA, Agarwal S, et al. Choice of hemostatic agent influences adhesion formation in a rat cecal adhesion model. J Surg Res. 2009;155(1):77–81. doi:10.1016/j.jss.2008.08.008

 PubMed Web of Science ®Google Scholar

Emmez H, Tonge M, Tokgoz N, et al. Radiological and histopathological comparison of microporous polysaccharide hemospheres and oxidized regenerated cellulose in the rabbit brain: a study of efficacy and safety. Turk Neurosurg. 2010;20(4):485–491. Turkish. doi:10.5137/1019-5149.JTN.3300-10.2

 PubMed Web of Science ®Google Scholar

Ereth MH, Schaff M, Ericson EF, et al. Comparative safety and efficacy of topical hemostatic agents in a rat neurosurgical model. Neurosurgery. 2008;63(4 SUPPL):ONS369–ONS72.

 Web of Science ®Google Scholar

MacDonald MH, Wang AY, Clymer JW, et al. An in vivo comparison of the efficacy of hemostatic powders, using two porcine bleeding models. Med Devices. 2017;10:273–279. doi:10.2147/MDER.S140663

 Google Scholar

Singh RK, Baumgartner B, Mantei JR, et al. Hemostatic comparison of a polysaccharide powder and a gelatin powder. J Invest Surg. 2019;32(5):393–401. doi:10.1080/08941939.2017.1423421

 PubMed Web of Science ®Google Scholar

Ereth MH, Dong Y, Schrader LM, et al. Microporous polysaccharide hemospheres do not enhance abdominal infection in a rat model compared with gelatin matrix. Surg Infect. 2009;10(3):273–276. doi:10.1089/sur.2007.033

 PubMed Web of Science ®Google Scholar

Antisdel JL, Janney CG, Long JP, Sindwani R. Hemostatic agent Microporous Polysaccharide Hemospheres (MPH) does not affect healing or intact sinus mucosa. Laryngoscope. 2008;118(7):1265–1269. doi:10.1097/MLG.0b013e31816c7bc9

 PubMed Web of Science ®Google Scholar

Ereth M, Sibonga J, Oliver W, et al. Microporous polysaccharide hemospheres do not inhibit bone healing compared to bone wax or microfibrillar collage. Orthopedics. 2008;31(3):1–4.

 Google Scholar

Bruckner BA, Loebe M. Microporous polysaccharide hemosphere absorbable hemostat (AristaAH) use in re-operative cardiac surgical procedures. US Cardiol. 2012;9(2):96–98. doi:10.15420/usc.2012.9.2.96

 Google Scholar

Bruckner BA, Loebe M. The use of an absorbable microporous polysaccharide hemosphere haemostat (AristaAH) in ventricular assist device implant and cardiac transplantation procedures. Eur Cardiol. 2012;8(2):125–127. doi:10.15420/ecr.2012.8.2.125

 Google Scholar

Galarza M, Porcar OP, Gazzeri R, Martnez-Lage JF. Microporous Polysaccharide Hemospheres (MPH) for cerebral hemostasis: a preliminary report. World Neurosurg. 2011;75(3–4):491–494. doi:10.1016/j.wneu.2010.10.008

 PubMed Web of Science ®Google Scholar

Phillips PP. Safety and efficacy of Arista powder in 514 nasal septal and sinus surgery patients. Otolaryngology. 2013;149(2):P135. doi:10.1177/0194599813495815a301

 Google Scholar

Sindwani R. Use of novel hemostatic powder MPH for endoscopic sinus surgery: initial impressions. Otolaryngology. 2009;140(2):262–263. doi:10.1016/j.otohns.2008.11.009

 Google Scholar

Bruckner BA, Blau LN, Rodriguez L, et al. Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures. J Cardiothor Surg. 2014;9(1):134. doi:10.1186/s13019-014-0134-4

 PubMedGoogle Scholar

Reynbakh O, Akhrass P, Souvaliotis N, et al. Use of MPH hemostatic powder for electrophysiology device implantation reduces postoperative rates of pocket hematoma and infection. Curr Med Res Opin. 2018;34(10):1861–1867. doi:10.1080/03007995.2018.1476847

 PubMed Web of Science ®Google Scholar

Antisdel JL, West-Denning JL, Sindwani R. Effect of microporous polysaccharide hemospheres (MPH) on bleeding after endoscopic sinus surgery: randomized controlled study. Otolaryngology. 2009;141(3):353–357. doi:10.1016/j.otohns.2009.06.078

 Google Scholar

Antisdel JL, Matijasec JL, Ting JY, Sindwani R. Microporous polysaccharide hemospheres do not increase synechiae after sinus surgery: randomized controlled study. Am J Rhinol Aller. 2011;25(4):268–271. doi:10.2500/ajra.2011.25.3619

 PubMed Web of Science ®Google Scholar

Suarez-Kelly LP, Pasley WH, Clayton EJ, et al. Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial. BMC Cancer. 2019;19(1). doi:10.1186/s12885-019-5293-1

 PubMedGoogle Scholar

Nunez-Nateras R, Hurd KJ, Ferrigni EN, et al. Athermal nerve sparing robot-assisted radical prostatectomy: initial experience with microporous polysaccharide hemospheres as a topical hemostatic agent. World j Urol. 2013;31(3):523–527. doi:10.1007/s00345-011-0815-8

 PubMed Web of Science ®Google Scholar

Gilbert DR, Angell J, Abaza R. Evaluation of absorbable hemostatic powder for prevention of lymphoceles following robotic prostatectomy with lymphadenectomy. Urology. 2016;98:75–80. doi:10.1016/j.urology.2016.06.071

 PubMed Web of Science ®Google Scholar

Gleason S, Mehl D, Payne W, et al. Microporous polysaccharide hemosphere efficacy and safety in primary total knee arthroplasty. J Orthopa. 2019;16(1):19–24. doi:10.1016/j.jor.2018.11.006

 PubMed Web of Science ®Google Scholar

Bard Davol Inc. AristaTM AH Instructions for Use. PK3798864; 2015.

 Google Scholar

Palacios DA, McDonald M, Miyake M, Rosser CJ. Pilot study comparing the two hemostatic agents in patients undergoing partial nephrectomy. BMC Res Notes. 2013;6(1):399. doi:10.1186/1756-0500-6-399

 PubMedGoogle Scholar

Antisdel JL, Meyer A, Comer B, et al. Product comparison model in otolaryngology: equivalency analysis of absorbable hemostatic agents after endoscopic sinus surgery. Laryngoscope. 2016;126(Supplement 2):S5–S13. doi:10.1002/lary.25678

 PubMedGoogle Scholar