Effective Treatment of Anticoagulated Patients with Novel Transforming Powder Dressing (TPD)

Anticoagulants can contribute to wound healing complications by accelerating bleeding and exudation. Even minor injuries may evolve into severe soft tissue damage with increased risk of hematomas. Resulting wounds may be extensive, painful, and debilitating with high risk of infection and tissue necrosis, imposing a significant wound care challenge with limited treatment alternatives.1

Conventional dressings require frequent changes exacerbating wound trauma and patient discomfort. Another routine therapy, negative pressure wound therapy (NPWT), has been associated with bleeding complications. Between 2009 and 2011, FDA reported six deaths and 77 injuries associated with NPWT; bleeding complications were prevalent in all six deaths and 17 injuries (including certain patients on anticoagulant therapy).2 Alternative therapies, therefore, must be evaluated. We present a complex case treated with a novel transforming powder dressing (TPD).

TPD’s biocompatible polymers aggregate upon hydration to form a moist, oxygen-permeable matrix that protects the wound from contamination while managing exudate through vapor transpiration. Once applied, TPD may be left on (and topped off as needed) without full dressing changes for up to 30 days.

TPD dries and flakes off as the wound heals. An 88-year-old male with multiple comorbidities including atrial fibrillation was being treated with Apixaban to reduce the risk of stroke and systemic embolism. The patient reported a fall, wounding his right lower extremity (RLE). His pain increased and wound worsened despite standard of care therapy. Computed Tomography Angiography revealed a large, superficial hematoma in the lateral aspect of the right calf.

Acute blood loss anemia secondary to the hematoma was observed and DVT prophylaxis was discontinued. Excisional wound debridement and evacuation of the hematoma was performed eleven days after the initial injury. TPD was applied to the wound (20cm x 10cm x 3cm) post-surgery and continued during home healthcare visits. The patient experienced reduced pain, minimal bleeding, and significant decrease in sanguineous drainage. Expedited granulation was observed and the wound was ready for grafting within 35 days. At the time of abstract submission, the patient was awaiting surgical feedback regarding grafting and the wound care team had recommended secondary intention wound healing with TPD.