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Clinical and Economic Value

The impact and complexities of bleeding in surgery
Embracing the intricacies and impact of bleeding in surgery is the foundation of our vision across our hemostatic innovation.
Many patients today are entering the operating room with factors that can cause disruptive bleeding; creating both challenges for the staff and danger for the patient.
To better understand the bleeding situations that occur in the OR, we initiated a robust quantitative study across ~8,000 individual bleeding occasions, and 450 surgeons across 11 surgical specialties as a starting point.1

Optimizing hospital costs through HOP improvements
Ethicon’s evidence-based, Hemostasis Optimization Program (HOP) offers a systematic approach to surgical bleeding. It provides guidance on selecting the right adjunctive hemostat for the right bleeding site and situation. The program has been proven to reduce surgical variation, maximize efficiency and improve outcomes.2
The bleeding situations that occur in surgery and drive our Hemostasis Optimization Program.

Continuous Oozing
This type of bleeding will not stop with simple compression or packing. It is more time consuming than difficult to address in a procedure.2

Difficult to Access
Bleeding that occurs in tight and irregular spaces. You cannot see the exact source of the bleed and you are concerned that accessing a tight space will cause more harm.2

Potential Re-Bleeding Risk
This type of bleeding may be addressed intraoperatively, but could later develop into more serious complications, especially in high risk patients.2

Problematic Bleeding
This type of bleeding is accessible but could be trouble. It is more than routine, likely to be resistant to conventional means, requires immediate attention, and causes disruption to the normal progression of surgery.3

Continuous Oozing
Our solution for continuous oozing is our SURGICEL™ Family of products; SURGICEL™ Powder Absorbable Hemostat, SURGICEL SNoW™ Absorbable Hemostat, SURGICEL™ FIBRILLAR Absorbable Hemostat, SURGICEL NU-KNIT™ Absorbable Hemostat and SURGICEL™ Original Absorbable Hemostat. These products are associated with:4
- Up to 25% less product usage
- 38-52% lower transfusion costs
- Up to 15% reduction in length of stay

Difficult to Access
Our solution for bleeding in tight and irregular sites is SURGIFLO® Hemostatic Matrix. This product is associated with:
- Up to 25% reduction in blood loss5
- Reduction in OR time of up to 24 minutes6
- Hospital length of stay reduced by up to 2 days7

Potential Re-Bleeding
Our solution for potential re-bleeding is VISTASEAL™ Fibrin Sealant (Human). This product is associated with:
- Sustained hemostasis in high-risk patients8-12
- A durable clot regardless of the patient’s coagulation profile, mimicking the clot formation process and forming a rapid adherent clot10-13
- Faster prep than any other fibrin sealants on the marketA14
- Performance, simplicity and ease of use
A. Based on number of set‐up steps and thawing time required for VISTASEAL™ Dual Applicator vs competitors.

Problematic Bleeding
Our Solution for problematic bleeding is EVARREST® Fibrin Sealant Patch. This product is associated with:
- Can stop challenging bleeding on the first attempt.B15-17
- Demonstrated superior hemostatic efficacy in 4 randomized controlled clinical trials across a spectrum of challenging bleeding situations and surgical procedures.B15-17
- Economic value based on superior hemostatic efficacy in clinical trials for EVARREST versus conventional adjunctive hemostats or TachoSil® Fibrin Sealant Patch.17-23
B. EVARREST demonstrated hemostatic superiority across 4 clinical trials. Trial 1: Soft Tissue hemorrhage: Per protocol efficacy measured at n=87, 100% vs 53.3% for Surgicel Δ 46.7% P<0.0001; (ITT population=90). Trial 2: Normal and Abnormal liver resection hemorrhage: Per protocol efficacy measured at n=77, 94.3% vs 28.6% for conventional adjunctive methods Δ 65.7% P<0.001; (ITT population=84). Trial 3: Anatomic and nonanatomic liver resection hemorrhage: Per protocol efficacy measured at n=93, 97.9% vs 44.4% for conventional adjunctive methods Δ 53.5% P<.0001; (ITT population=102). Trial 4: Aortic reconstruction: Per protocol efficacy measured at n=141, 78.8% vs 46.7% for Tachosil Δ 32.1% P<0.0001; (ITT population=156)