Hemostatic devices and methods of use

An anchorage device is provided that is configured to surround an implantable medical device. The anchorage device includes a first component having a first substrate and a second component having a second substrate. The second component is positioned within the first component. One of the first and second substrates includes a hemostatic agent and the other of the first and second substrates includes an active pharmaceutical ingredient. Kits, systems and methods are disclosed.

TECHNICAL FIELD

The present disclosure generally relates to anchorage devices and methods configured for anchoring an implantable medical device within a body, wherein the anchorage device comprises at least one hemostatic agent that is configured to elute over time.

BACKGROUND

Some known anchorage devices may be used to secure an implantable medical device within a body of a patient. The anchorage device and implantable medical device can be inserted into a desired location within the body of the patient. The anchorage device can be used to help anchor or support the implantable medical device to surrounding tissue. Some known anchorage devices are used to provide temporary support to tissue during a healing process. For example, some known anchorage devices can secure one portion of tissue to another portion of tissue. It would be desirable to stop or reduce the flow of blood at a surgical site and/or speed up the blood clotting process while anchoring the implantable medical device to tissue. This disclosure describes an improvement over these prior art technologies.

SUMMARY

New anchorage devices and methods are provided for to help anchor or support an implantable medical device to surrounding tissue. In one embodiment, an anchorage device is provided that includes a first component having a first substrate and a second component having a second substrate. The second component is positioned within the first component. One of the first and second substrates includes a hemostatic agent and the other of the first and second substrates includes an active pharmaceutical ingredient.

In some embodiments, at least one of the first and second substrates comprises a first piece and a second piece that is joined with the first piece to form an envelope, pouch, or pocket in which, one side of the envelope, pouch, or pocket includes an opening to allow a device, such as, for example, the implantable medical device to be inserted through the opening and into a cavity of the envelope, pouch, or pocket. In some embodiments, the envelope, pouch, or pocket includes the hemostatic agent and/or the active pharmaceutical ingredient.

In some embodiments, the second substrate is a sheet. The sheet includes a first side and an opposite second side. In some embodiments, the hemostatic agent and/or the active pharmaceutical ingredient is applied to the first side and/or the second side. In some embodiments, the hemostatic agent is applied to the first side and the active pharmaceutical ingredient is applied to the second side.

In some embodiments, the sheet is made from the hemostatic agent. In some embodiments, the sheet that is made from the hemostatic agent has an active pharmaceutical ingredient applied to the sheet. In some embodiments, a polymer including the hemostatic agent and/or the active pharmaceutical ingredient agent releases the hemostatic agent and/or the active pharmaceutical ingredient agent over time in the area surrounding or adjacent to the anchorage device.

In some embodiments, the anchorage device includes a polymer that is applied to at least one of the first and second substrates. In some embodiments, the polymer covers all or a portion of the first substrate and/or the second substrate. In some embodiments, the polymer includes the hemostatic agent and/or the active pharmaceutical ingredient such that the hemostatic agent and/or the active pharmaceutical ingredient is/are released over time in an area surrounding or adjacent to the anchorage device.

DETAILED DESCRIPTION

This disclosure is directed to anchorage devices, such as, for example, an anchorage device20. In some embodiments, the components of anchorage device20can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, allografts, xenografts, isografts, ceramics and bone material and/or their composites, depending on the particular application and/or preference of a medical practitioner. For example, the components of anchorage device20, individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, super elastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL® manufactured by Toyota Material Incorporated of Japan), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™ manufactured by Biologix Inc.), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO4polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, tyrosine polyarylate, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, for example, composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, composites of PEEK with resorbable polymers, totally resorbable materials, such as, for example, calcium based ceramics such as calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymers such as polylactide, polyglycolide, polytyrosine carbonate, polycaroplactone and their combinations.

Various components of anchorage device20may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of anchorage device20, individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of anchorage device20may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein.

Substrates

Anchorage device20includes a first component22comprising a first substrate24and a second component26comprising a second substrate28.

In some embodiments, first substrate24is a pocket or envelope in which second component26and/or an implantable medical device can be at least partially disposed. That is, substrate22is a pouch, bag, covering, shell, or receptacle. For example, substrate22can include a first piece22aand a second piece22bthat is joined with first piece22a. First and second pieces22a,22bare joined to form the pocket or envelope. In some embodiments, first and second pieces22a,22bare joined along three sides of the pocket or envelope to form a cavity C, as shown inFIG. 6, for example. First and second pieces22a,22bare not joined at a fourth side of the pocket or envelope to define an opening O such that an implantable medical device can be inserted through opening O and into cavity C to enclose, encase or surround all or a portion of the implantable medical device within cavity C. In some embodiments, first and second pieces22a,22bare joined with one another along three sides of the pocket or envelope by heat, ultrasonically, bonding, knitting, or adhesive. In some embodiment, the pocket or envelope is monolithically formed by molding the pocket or envelope or producing the pocket or envelope by 3D printing, for example.

In some embodiments, anchorage device20includes one or a plurality of arms, such as, for example, extensions22cthat extend outwardly from the pocket formed by first and second pieces22a,22b, as shown inFIG. 22. In some embodiments, extensions22care spaced apart from one another and/or are positioned radially about the pocket. In some embodiments, at least one of extensions22cincludes one or a plurality of openings23that extends through a thickness of extension22c. Openings23are spaced apart along a length of extension23. In some embodiments, openings23each have the same width or diameter. In some embodiments, openings23each have an oval or oblong shape. Extensions22care configured to be coupled to tissue when anchorage device20is inserted into an area, such as, for example, a body cavity to secure an implantable medical device within the pocket to the body. In some embodiments, at least one of extensions22cis made from a biodegradable and/or resorbable material. In some embodiments, at least one of extensions22cis made from a biodegradable and/or resorbable material that degrades and/or resorbs at a faster rate than the pocket such that the pocket with the implantable medical device within the pocket remains after extensions22cdegrade and/or resorb. In some embodiments, at least one of extensions23is made from a single layer of material to allow extensions to degrade and/or resorb at a faster rate than the pocket, which is formed from two layers of material (e.g., first and second pieces22a,22b). In some embodiments, extensions22cand first and second pieces22a,22bare made from the same material. In some embodiments, extensions22cand first and second pieces22a,22bare made different materials. In some embodiments, at least one of extensions22cis made from a first material and at least one of extensions22cis made from a second material that is different than the first material. The first and second materials may include any of the materials discussed herein. In some embodiments, at least one of extensions22cis made from a hemostatic material. In some embodiments, at least one of extensions22chas a hemostatic agent, such as, for example, one or more of the hemostatic agents discussed herein, applied to extensions22c. The hemostatic agent may be applied to extensions22cin the same manner the hemostatic agents discussed herein are applied to substrate22. In some embodiments, extensions22ceach have the same amount of the hemostatic agent. In some embodiments, at least one of extensions22chas a first amount of the hemostatic agent and at least one of extensions22chas a second amount of the hemostatic agent that is different than the first amount. In some embodiments, at least one of extensions22cincludes a first hemostatic agent and at least one of extensions22cincludes a second hemostatic agent that is different than the first hemostatic agent. In some embodiments, at least one of extensions22cincludes an active pharmaceutical ingredient, such as, for example, one or more of the active pharmaceutical ingredients discussed herein, in addition to in in place of the hemostatic agent. In some embodiments, at least one of extensions22cmay be cut or otherwise severed from the pocket before or after anchorage device is implanted within a patient. In some embodiments, at least one of extensions22cis scored to facilitate the removal of extensions22cfrom the pocket. This allows a medical practitioner to customize anchorage device20such that anchorage device only includes the amount of extensions22crequired to secure anchorage device20within a patient. That is, any extraneous extensions22ccan be removed prior to or after implantation of anchorage device20.

A substrate, such as, for example, substrate22, is configured to be coupled to and/or applied to a device, such as, for example, an implantable medical device or a non-implantable medical device, as discussed herein. In some embodiments, substrate22is configured to surround and/or enclose at least a portion of the implantable medical device, as discussed herein. Substrate22is configured to be secured to tissue to support the implantable medical device at a treatment site. Implantable medical devices include, for example, neurostimulators, vascular devices such as grafts (e.g., abdominal aortic aneurysm grafts, etc.), stents, catheters (including arterial, intravenous, blood pressure, stent graft, etc.), valves (e.g., polymeric or carbon mechanical valves), embolic protection filters (including distal protection devices), vena cava filters, aneurysm exclusion devices, artificial hearts, cardiac jackets, and heart assist devices (including left ventricle assist devices), implantable defibrillators, subcutaneous implantable defibrillators, implantable monitors, for example, implantable cardiac monitors, electrostimulation devices and leads (including pacemakers, lead adapters and lead connectors), implanted medical device power supplies, peripheral cardiovascular devices, atrial septal defect closures, left atrial appendage filters, valve annuloplasty devices, mitral valve repair devices, vascular intervention devices, ventricular assist pumps, and vascular access devices (including parenteral feeding catheters, vascular access ports, central venous access catheters). Implantable medical devices may also include, for example, surgical devices such as sutures of all types, anastomosis devices (including anastomotic closures), suture anchors, hemostatic barriers, screws, plates, clips, vascular implants, tissue scaffolds, cerebro-spinal fluid shunts, shunts for hydrocephalus, drainage tubes, catheters including thoracic cavity suction drainage catheters, abscess drainage catheters, biliary drainage products, and implantable pumps. Implantable medical devices may also include, for example, orthopedic devices such as joint implants, acetabular cups, patellar buttons, bone repair/augmentation devices, spinal devices (e.g., vertebral disks and the like), bone pins, cartilage repair devices, and artificial tendons. Implantable medical devices may also include, for example, dental devices such as dental implants and dental fracture repair devices.

Implantable medical devices may also include, for example, drug delivery devices such as drug delivery pumps, implanted drug infusion tubes, drug infusion catheters, and intravitreal drug delivery devices. Implantable medical devices may also include, for example, ophthalmic devices such as scleral buckles and sponges, glaucoma drain shunts and intraocular lenses. Implantable medical devices may also include, for example, urological devices such as penile devices (e.g., impotence implants), sphincter, urethral, prostate, and bladder devices (e.g., incontinence devices, benign prostate hyperplasia management devices, prostate cancer implants, etc.), urinary catheters including indwelling (“Foley”) and non-indwelling urinary catheters, and renal devices. Implantable medical devices may also include, for example, synthetic prostheses such as breast prostheses and artificial organs (e.g., pancreas, liver, lungs, heart, etc.). Implantable medical devices may also include, for example, respiratory devices including lung catheters. Implantable medical devices may also include, for example, neurological devices such as neurostimulators, neurological catheters, neurovascular balloon catheters, neuro-aneurysm treatment coils, and neuropatches, splints, ear wicks, ear drainage tubes, tympanostomy vent tubes, otological strips, laryngectomy tubes, esophageal tubes, esophageal stents, laryngeal stents, salivary bypass tubes, and tracheostomy tubes. Implantable medical devices may also include, for example, oncological implants. Implantable medical devices may also include, for example, pain management implants.

In some embodiments, substrate22is configured to be coupled to and/or applied to or to surround and/or enclose at least a portion of a non-implantable medical device, as discussed herein. Non-implantable devices can include dialysis devices and associated tubing, catheters, membranes, and grafts; autotransfusion devices; vascular and surgical devices including atherectomy catheters, angiographic catheters, intraaortic balloon pumps, intracardiac suction devices, blood pumps, blood oxygenator devices (including tubing and membranes), blood filters, blood temperature monitors, hemoperfusion units, plasmapheresis units, transition sheaths, dialators, intrauterine pressure devices, clot extraction catheters, percutaneous transluminal angioplasty catheters, electrophysiology catheters, breathing circuit connectors, stylets (vascular and non-vascular), coronary guide wires, peripheral guide wires; dialators (e.g., urinary, etc.); surgical instruments (e.g. scalpels and the like); endoscopic devices (such as endoscopic surgical tissue extractors, esophageal stethoscopes); and general medical and medically related devices including blood storage bags, umbilical tape, membranes, gloves, surgical drapes, wound dressings, wound management devices, needles, percutaneous closure devices, transducer protectors, pessary, uterine bleeding patches, PAP brushes, clamps (including bulldog clamps), cannulae, cell culture devices, materials for in vitro diagnostics, chromatographic support materials, infection control devices, colostomy bag attachment devices, birth control devices; disposable temperature probes; and pledgets.

Substrate22can have a variety of different configurations, shapes and sizes. For example, substrate22can be provided with a size and shape or other configuration that can provide the functionality of supporting and immobilizing the implantable medical device at a treatment site within a patient's body, while also improving the removability of anchorage device20after the treatment has been completed. In some embodiments, the implantable medical device can be disposed within ae pocket defined by substrate22and anchorage device20can be implanted and secured to tissue at a desired treatment site within a body of a patient. As discussed herein, during implantation, scar tissue can form at the treatment site and/or tissue can become ingrown within substrate22. After the treatment is completed, the implantable medical device can be removed from the patient leaving anchorage device20implanted. To remove anchorage device20, tissue that is ingrown within substrate22can be cut or otherwise detached from substrate22. In some embodiments, a portion of anchorage device20may not be removable from the tissue and will remain implanted within the patient.

Substrate22may be formed with one or more biocompatible materials, which may be synthetic or naturally occurring. In some embodiments, the one or more biocompatible materials include, for example, polypropylene, polyester, polytetrafluoroethylene, polyamides, silicones, polysulfones, metals, alloys, titanium, stainless steel, shape memory metals (e.g. Nitinol), and/or combinations thereof.

In some embodiments, substrate22is configured to be implanted temporarily within a body of a patient and/or is configured to be removed (e.g., explanted) from the patient's body after a period of time. In such embodiments, substrate22may include a non-biodegradable material and/or a non-bioresorbable material. For example, substrate22may be made entirely from a non-biodegradable material and/or a non-bioresorbable material such that substrate22is made only from the non-biodegradable material and/or non-bioresorbable material. In some embodiments, substrate22may include one or more non-biodegradable and/or a non-bioresorbable material and one or more biodegradable and/or resorbable material. In some embodiments, one side of substrate22may include one or more non-biodegradable and/or a non-bioresorbable material and another side of substrate22can include one or more biodegradable and/or resorbable material.

As used herein, the term “biodegradable” refers to, for example, a material that can be at least partially broken down or degraded by a bodily fluid and discarded as waste from the body and/or a material that can be broken down or degraded by a living organism. Thus, “non-biodegradable” can refer to a material that cannot be broken down or degraded by a bodily fluid and/or cannot be broken down or degraded by a living organism. As used herein the term “resorbable” refers to, for example, a material that can be at least partially broken down or degraded by a bodily fluid and assimilated within the body. Thus, a “non-resorbable” material as used herein can refer to, for example, a material that cannot be broken down or degraded by bodily fluid and assimilated within the body.

In some embodiments, substrate22is configured to be permanently implanted within a body of a patient. In such embodiments, substrate22may include a biodegradable material and/or a bioresorbable material. For example, substrate22may be made entirely from a biodegradable material and/or a bioresorbable material such that substrate22is made only from the biodegradable material and/or bioresorbable material.

In some embodiments, substrate22is provided in the form of a mesh, as shown inFIGS. 1-10. In some embodiments, the mesh is web or fabric with a construction of knitted, braided, woven or non-woven filaments or fibers F that are interlocked in such a way to create a fabric or a fabric-like material that includes a matrix of filaments that define multiple pores P. That is, the space between adjacent filaments or fibers F define pores P of the mesh. Pores P may be beneficial to allow tissue in-growth, for example. In some embodiments, apertures may be formed in the mesh by cutting the filaments or fibers F to decrease the areal density (e.g., surface density) or mass of the mesh and/or further facilitate tissue in-growth. In some embodiments, the apertures that extend through the filaments or fibers F are larger than pores P defined by the filaments or fibers F.

In some embodiments, substrate22is provided in the form of a thin walled structure, such as, for example, a wafer, sheet or tissue. In some embodiments, the thin walled structure does not include any pores or apertures, in contrast to the mesh discussed herein. In some embodiments, the thin walled structure includes pores or apertures that are smaller than the pores or apertures of the mesh discussed herein. In some embodiments, the thin walled structure has a thickness that is less than a thickness of the mesh discussed herein. In some embodiments, the thickness of the thin walled structure is between about 0.001 inches and about 0.1 inches.

In some embodiments, substrate22is a planar sheet, as shown inFIG. 2. In some embodiments, the planar sheet is in the form of a mesh. In some embodiments, the planar sheet is in the form of a thin walled structure. The planar sheet has a first side and an opposite second side, similar to a sheet of paper. The planar sheet can be manipulated about all or only a portion of an implantable medical device, such as, for example, one of the implantable medical devices discussed herein. In some embodiments, the planar sheet is moldable or bendable about the implantable medical device. That is, the planar sheet can be bent without breaking the planar sheet. In some embodiments, the planar sheet can be manipulated to form a tube, for example. In some embodiments, the planar sheet has a rigid configuration. That is, the planar sheet cannot be bent without breaking the planar sheet. In some embodiments, the planar sheet can be secured to tissue to support the implantable medical device at the treatment site. The planar sheet can be variously shaped, such as, for example, circular, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered.

In some embodiments, substrate22is a scaffold, a sponge, woven, non-woven, knitted or non-knitted. In some embodiments, substrate22can be formed by extrusion.

In some embodiments, first and second pieces22a,22bare portions of a single sheet that is bent to produce a fold at one end of the pocket or envelope. First and second pieces22a,22bare joined along sides of the pocket or envelope that extend transverse to the fold such that the fold and the sides of the pocket or envelope do not have any openings. First and second pieces22a,22bare not joined at an end of the pocket or envelope opposite the fold to define an opening at the end such that a medical device can be inserted through the opening and into a cavity defined by inner surfaces of first and second pieces22a,22b.

In some embodiments, first and second pieces22a,22beach include a mesh discussed herein. In some embodiments, first piece22aincludes a mesh including pores having a first size and second piece22bincludes a mesh including pores having a second size, wherein the first size is different than the first size. In some embodiments, the first size is greater than the second size. In some embodiments, the first size is less than the second size. In some embodiments, first and second pieces22a,22beach include a thin walled structure discussed herein. In some embodiments one of first and second pieces22a,22bincludes a mesh discussed herein and the other one of first and second pieces22a,22bincludes a thin walled structure discussed herein that does not have any pores or apertures.

In some embodiments, first and second pieces22a,22bare formed from the same material. In some embodiments one of first and second pieces22a,22bis formed from a first material, such as, for example, one of the materials discussed herein, and the other one of first and second pieces22a,22bis made from a second material, such as, for example, one of the materials discussed herein, wherein the second material is different than the first material. For example, first piece22amay be formed from a biodegradable and/or bioresorbable material and second piece22bmay be formed from a non-biodegradable and/or non-bioresorbable material, or vice versa. In some embodiments, first and second pieces22a,22bare each formed from a biodegradable and/or bioresorbable material, wherein the biodegradable and/or bioresorbable materials degrade and/or resorb at the same rate. In some embodiments, first and second pieces22a,22bare formed from different biodegradable and/or bioresorbable materials, wherein one of the biodegradable and/or bioresorbable materials degrades and/or resorbs more quickly than the other biodegradable and/or bioresorbable material.

In some embodiments, first and second pieces22a,22beach include a single layer of material, such as, for example, one of the materials discussed herein. In some embodiments, at least one of first and second pieces22a,22bincludes multiple layers. In some embodiments, the multiple layers include more than one layer of the mesh discussed herein. In some embodiments, the multiple layers include more than one layer of the thin walled structure discussed herein. In some embodiments, the multiple layers include one or more layer of the mesh discussed herein and one or more layer of the thin walled structure discussed herein. In some embodiments, the multiple layers include one or more layer of the mesh discussed herein and one or more layer of the thin walled structure discussed herein, wherein one of the layers of mesh is positioned between two layers of the thin walled structure. In some embodiments, the multiple layers include one or more layer of the mesh discussed herein and one or more layer of the thin walled structure discussed herein, wherein one of the layers of thin walled structure is positioned between two layers of the mesh.

Anchorage device20includes an agent, such as, for example, a hemostatic agent24. Hemostatic agent24can include one more hemostatic agent, such as, for example, epinephrine, tranexamic acid, chitosan and oxidized regenerated cellulose. In some embodiments, hemostatic agent24can include one or more of Spongostan®, Surgifoam®, Avitene, thrombin and Ostene® in addition to or in place of the hemostatic agents discussed above. In some embodiments, hemostatic agent24can include one or more of protamine, norepinephrine, desmopressin, lysine analogs, collagen, gelatin, polysaccharide spheres, mineral zeolite, bovine thrombin, pooled human thrombin, recombinant thrombin, gelatin and thrombin, collagen and thrombin, cyanacrylate, fibrin glue, polyethylene glycol, and glutaraldehyde in addition to or in place of the hemostatic agents discussed above. In some embodiments, the lysine analog is tranexamic acid and has the formula:

In some embodiments, the anchorage devices disclosed herein utilize one or more pharmacologic hemostatic agent since pharmacologic hemostatic agents have been found to be desirable over mechanical hemostats for a variety of reasons. Ethnographic research has showed that physicians desire a hemostat that can provide an extended elution profile to reduce bleeding events for up to 7 days post operatively. Furthermore, there is a possible effect on handling and/or allergic reactions if mechanical hemostats, such as, for example, oxidized reduced cellulose or chitosan were used.

In some embodiments, tranexamic acid is preferred for use as hemostatic agent24. Tranexamic acid is a synthetic analog of the amino acid lysine with a molecular weight of 157 g/mol. Tranexamic acid is an antifibrinolytic agent that acts by binding to plasminogen and blocking the interaction of plasminogen with fibrin, therefore preventing the dissolution of a fibrin clot. In the presence of a wound, fibrinolysis occurs naturally when a lysine residue such as tissue plasminogen activator (tPA), binds to plasmin causing the clot to lyse (or break). Tranexamic acid blocks tPA and keeps the clot from breaking, thus preventing unwanted bleeding.FIG. 23depicts this process.

Prior to a damaged endothelium, tPA is inhibited in the blood by plasminogen activator inhibitor/type 1 (PAI-1). Once damage occurs, the tPA is released slowly into the blood, activating fibrinolysis. Excessive fibrinolysis results in a condition called hvperfibrinolysis, which requires intervention such as fibrinogen, plasma, transfusion or antifibrinolytic therapy, such as tranexamic acid.

Tranexamic acid has been used for over 40 years to reduce bleeding complications. Tranexamic acid is most commonly given systemically at doses of 10 mg/kg followed by infusion of 10 mg/kg/h. Since 2007, tranexamic acid has received widespread approval and clinical use as a hemostatic agent. Knowing that surgical trauma causes fibrinolysis in the area of the surgical wound itself, topical antifibrinolytic therapy is becoming more common to obtain and maintain hemostasis. Clinical trials with topical tranexamic acid use exist for cardiac surgery, CIED procedures, orthopedic surgery, spinal surgery, dental extraction and epistaxis, and breast mammoplasty.

To evaluate the efficacy of tranexamic acid, a non-GLP acute porcine study was conducted. Doses of 1 mg to 200 mg of tranexamic acid were used in an in vitro whole blood coagulation test, a hepatic biopsy test, and a subcutaneous ICD surgical procedure.

The in vitro whole blood coagulation test showed no activity for tranexamic acid up to 10 mg/ml. The maximum tranexamic acid concentration, 200 mg/5 ml, was a slightly higher dose than that used clinically in a CIED pocket if 50 cc is the assumed blood volume of interest. Coagulation time was doubled with this higher dose.

The hepatic biopsy test had a volume of 0.016 ml when the biopsy hole was filled with blood. The minimum tranexamic acid dose evaluated was 2.5 mg, which is equivalent to 156 mg/ml. This concentration prevents blood from clotting quickly and these biopsies continued to bleed past the endpoint of 10 minutes. This phenomenon is likely due to the multiple bonding sites available to tranexamic acid in whole blood, and the fact that a biopsy does not induce fibrinolysis.

The subcutaneous surgical site test was conducted with an elevated ACT using heparin to induce hematoma. Surgical trauma similar to that of a CIEO implant was incurred in each pocket, but some subcutaneous pockets incurred more trauma than others due to anatomical location. The primary output monitored was accumulated blood as measured by pre-weighed gauze 3-hours post-operatively. With only one animal, and two pockets per treatment, the sample size was too low to show any significance between ICD only, ICD+polymer, and ICD+polymer+tranexamic acid.

The non-GLP acute porcine study showed that in the dose range evaluated, tranexamic acid has a two-fold increase on clotting time and no effect on reducing bleeding on the hepatic biopsies. In the heparinized ICD pocket procedure, 3.5-22.8 grams of blood accumulated in a 3-hour period of time regardless of treatment. It appears that subcutaneous pockets in an anticoagulated porcine model would be a translatable model for evaluating efficacy of tranexamic acid because it has a relevant volume of accumulated blood and surgical trauma similar to that of a CIED procedure.

Based upon the non-GLP acute porcine study, tranexamic acid concentrations of 3.00 mg/L to 30 mg/L are effective in preventing fibrinolysis. As such, in some embodiments, hemostatic agent24is tranexamic acid and is provided in concentrations of about 3.00 mg/L to about 30 mg/L. However, it has been found that one tenth of the doses used in the non-GLP acute porcine study can be effective in reversing fibrinolysis. As such, in some embodiments, hemostatic agent24is tranexamic acid and is provided in concentrations of about 0.30 mg/L to about 3.0 mg/L for intravenous applications. In some embodiments, tranexamic acid is provided in concentrations of about 3.78 mg/L to about 30 mg/L for topical applications as well. However, in some embodiments, however, higher doses of tranexamic acid are used for topical applications to account for tranexamic acid being widely distributed throughout the extracellular and intracellular compartments when given preoperatively. Indeed, it has been found that tranexamic acid reaches plasma concentrations in 5-15 minutes. As such, in some embodiments, tranexamic acid is provided in doses of about 1.5 mg to about 150 mg.

In some embodiments, hemostatic agent24includes a mixture or combination of the hemostatic agents discussed herein. In some embodiments, hemostatic agent24is applied directly to substrate22, as shown inFIG. 2. That is, hemostatic agent24is not applied to substrate22in a polymer, such as, for example, a polymer that includes hemostatic agent24. In some embodiments, hemostatic agent24may be applied to substrate22by spraying hemostatic agent24onto substrate22, coating all or a portion of substrate22with hemostatic agent24, coating all or a portion of substrate22with a material, such as, for example, applying a polymer to substrate22that includes hemostatic agent24, washing substrate22with hemostatic agent24, or printing hemostatic agent24on substrate22with a printer, such as, for example a 3D printer. In some embodiments, hemostatic agent24is a material that forms substrate22, as shown inFIG. 3. That is, substrate22is made from hemostatic agent24. In some embodiments, substrate22is made only from hemostatic agent24.

In embodiments discussed herein wherein anchorage device20is a planar sheet, the planar sheet has opposite top and bottom surfaces and hemostatic agent24can be applied to at least one of the top and bottom surfaces. That is, hemostatic agent24may be applied to both the top and bottom surfaces, or only one of the top and bottom surfaces. In some embodiments, a first hemostatic agent24is applied to the top surface and a second hemostatic agent24is applied to the bottom surface, wherein the first hemostatic agent24is different than the second hemostatic agent24. In some embodiments, a first hemostatic agent24is applied to the top surface and a second hemostatic agent24is applied to the bottom surface, wherein the first hemostatic agent24includes a different amount of hemostatic agent24than the second hemostatic agent24.

In embodiments discussed herein wherein anchorage device20is a pocket or envelope, hemostatic agent24can be applied to at least one of first piece22aand second piece22b. In some embodiments, only one of first and second pieces22a,22bincludes hemostatic agent24. In some embodiments, hemostatic agent24is applied only to opposite outer surfaces of first and second pieces22a,22b. That is, the inner surfaces of first and second pieces22a,22bthat face one another and define cavity C do not have hemostatic agent24applied thereto. In some embodiments, hemostatic agent24is applied only to the inner surfaces of first and second pieces22a,22bthat define cavity C. That is, the opposite outer surfaces of first and second pieces22a,22bthat face away from one another do not have hemostatic agent24applied thereto. In some embodiments, hemostatic agent24is applied only to the inner surface of one of first and second pieces22a,22band to the outer surface of the other one of first and second pieces22a,22b.

In embodiments discussed herein wherein anchorage device20is a pocket or envelope, a first hemostatic agent24can be applied to first piece22aand a second hemostatic agent24can be applied to second piece22b, wherein the second hemostatic agent24is different than the first hemostatic agent24. In some embodiments, a first hemostatic agent24is applied to the outer surfaces of first and second pieces22a,22band a second hemostatic agent24is applied to the inner surfaces of first and second pieces22a,22b, wherein the second hemostatic agent24is different than the first hemostatic agent24.

Hemostatic agent24is configured to elute from anchorage device20into an area surrounding or adjacent to anchorage20to reduce or prevent bleeding within a patient, such as, for example, bleeding caused by a surgical procedure. The amount of hemostatic agent24that is applied to substrate22can be varied to elute a selected amount of hemostatic agent24and/or to elute hemostatic agent24at a selected rate and/or to elute hemostatic agent over a selected number of hours or days. In some embodiments, hemostatic agent24is eluted into surrounding bodily tissue, bodily fluid, or systemic fluid, to reduce or prevent bleeding. In some embodiments, hemostatic agent24may be eluted for up to 30 hours. In some embodiments, between about 40% and about 100% of hemostatic agent24is eluted over a period of at least about 30 hours. In some embodiments, 60% and about 100% of hemostatic agent24is eluted over a period of at least about 30 hours. In some embodiments, between about 65% and about 100% of hemostatic agent24is eluted over a period of at least about 36 hours. In some embodiments, 80% and about 100% of hemostatic agent24is eluted over a period of at least about 36 hours. In some embodiments, between about 60% and about 100% of hemostatic agent24is eluted over a period of at least about 48 hours. In some embodiments, 80% and about 100% of hemostatic agent24is eluted over a period of at least about 48 hours. In some embodiments, between about 60% and about 100% of hemostatic agent24is eluted over a period of at least about 60 hours. In some embodiments, 80% and about 100% of hemostatic agent24is eluted over a period of at least about 60 hours.

In some embodiments, anchorage device20may include a polymer that is applied to and/or coats at least a portion of substrate22, wherein the polymer includes hemostatic agent24. That is, hemostatic agent24is applied to substrate22via the polymer. In some embodiments, the polymer includes a combination, blend or mixture of polymers. In some embodiments, the polymer is configured to degrade within a patient and releases hemostatic agent24as the polymer degrades. In some embodiments, the degradation rate of the polymer is known or can be predicted to allow a medical practitioner to select a polymer or a quantity of polymer that is applied to substrate22to produce anchorage device20that is customized to elute a selected quantity of hemostatic agent24at a selected rate over a selected period of time. For example, the polymer may be selected to elute a selected quantity of hemostatic agent24per hour or day for a selected number of days or hours.

In some embodiments, the polymer is a polyarylate. In some embodiments, the polymer is a tyrosine-derived polyarylate. In some embodiments, the tyrosine-derived polyarylate is p(DTE co X % DT succinate), where X is about 10% to about 30%. In some embodiments, the tyrosine-derived polyarylate is p(DTE co X % DT succinate), where X ranges from about 26.5% to about 28.5%. In some embodiments, the tyrosine-derived polyarylate is p(DTE co X % DT succinate), where X is about 27.5%. In some embodiments, the polymer is P22-27.5 DT.

As used herein, DTE is the diphenol monomer desaminotyrosyl-tyrosine ethyl ester; DTBn is the diphenol monomer desaminotyrosyl-tyrosine benzyl ester; DT is the corresponding free acid form, namely desaminotyrosyl-tyrosine. BTE is the diphenol monomer 4-hydroxy benzoic acid-tyrosyl ethyl ester; BT is the corresponding free acid form, namely 4-hydroxy benzoic acid-tyrosine.

P22-XX is a polyarylate copolymer produced by condensation of DTE and DTBn with succinic acid followed by removal of benzyl group. P22-10, P22-15, P22-20, P22-XX, etc., represents copolymers different percentage of DT (i.e., 10, 15, 20 and % DT, etc.) In some embodiments, the polymer is produced by condensation of DTBn with succinic acid followed by removal of benzyl group. This polymer is represented as P02-100.

In some embodiments, the polymer includes one or more polyarylates that are copolymers of desaminotyrosyl-tyrosine (DT) and an desaminotyrosyl-tyrosyl ester (DT ester), wherein the copolymer comprises from about 0.001% DT to about 80% DT and the ester moiety can be a branched or unbranched alkyl, alkylaryl, or alkylene ether group having up to 18 carbon atoms, any group of which can, optionally have a polyalkylene oxide therein. Similarly, another group of polyarylates are the same as the foregoing but the desaminotyrosyl moiety is replaced by a 4-hydroxybenzoyl moiety. In some embodiments, the DT or BT contents include those copolymers with from about 1% to about 30%, from about 5% to about 30% from about 10 to about 30% DT or BT. In some embodiments, the diacids (used informing the polyarylates) include succinate, glutarate and glycolic acid.

In some embodiments, the polymer is one more polymers from the DTE-DT succinate family of polymers, e.g., the P22-xx family of polymers having from 0-50%, 5-50%, 5-40%, 1-30% or 10-30% DT, including but not limited to, about 1, 2, 5, 10, 15, 20, 25, 27.5, 30, 35, 40%, 45% and 50% DT. In some embodiments, the polymer is P22-27.5 DT.

In some embodiments, the polymer has diphenol monomer units that are copolymerized with an appropriate chemical moiety to form a polyarylate, a polycarbonate, a polyiminocarbonate, a polyphosphonate or any other polymer.

In some embodiments, the polymer is tyrosine-based polyarylate. In some embodiments, the polymer includes blends and copolymers with polyalkylene oxides, including polyethylene glycol (PEG).

In some embodiments, the polymer can have from 0.1-99.9% PEG diacid to promote the degradation process. In some embodiments, the polymer includes blends of polyarylates or other biodegradable polymers with polyarylates.

The polymer is configured to release hemostatic agent24over time, as discussed herein. In some embodiments, the polymer is configured to release hemostatic agent24over a time period ranging from about 1 hour to about 168 hours. In some embodiments, the polymer is configured to release hemostatic agent24over a time period ranging from 1 hour to 72 hours. In some embodiments, the polymer is configured to release hemostatic agent24over a time period ranging from 1 hour to 24 hours.

In some embodiments, the polymer is configured to release hemostatic agent24over time in an area surrounding or adjacent to anchorage device20(such as, for example, within the device “pocket” or within 3 inches in all dimensions). In some embodiments, the polymer is configured to release hemostatic agent24for up to 30 days. In some embodiments, the polymer is configured to release between about 40% and about 100% of hemostatic agent24over a period of at least about 30 hours. In some embodiments, the polymer is configured to release 60% and about 100% of hemostatic agent24over a period of at least about 30 hours. In some embodiments, the polymer is configured to release between about 65% and about 100% of hemostatic agent24over a period of at least about 36 hours.

In some embodiments, the polymer is configured to release 80% and about 100% of hemostatic agent24over a period of at least about 36 hours. In some embodiments, the polymer is configured to release between about 60% and about 100% of hemostatic agent24over a period of at least about 48 hours. In some embodiments, the polymer is configured to release 80% and about 100% of hemostatic agent24over a period of at least about 48 hours. In some embodiments, the polymer is configured to release between about 60% and about 100% of hemostatic agent24over a period of at least about 60 hours. In some embodiments, the polymer is configured to release 80% and about 100% of hemostatic agent24over a period of at least about 60 hours. In some embodiments, the polymer is configured to release 80% and about 100% of hemostatic agent24within 48 hours. In some embodiments, the polymer is configured to release 80% and about 100% of hemostatic agent24within 24 hours.

In some embodiments, the polymer is configured to release no more than 60% of hemostatic agent24within 24 hours. In some embodiments, the polymer is configured to release no more than 90% of hemostatic agent24after 60 hours. In some embodiments, the polymer is configured to release no more than 50% of hemostatic agent24within 12 hours. In some embodiments, the polymer is configured to release between about 40% and about 90% between 12 and 24 hours. In some embodiments, the polymer is configured to release between about 60% and about 100% between 24 and 36 hours. In some embodiments, the polymer is configured to release between about 65% and about 100% between 36 and 48 hours. In some embodiments, the polymer is configured to release between about 70% and about 100% between 48 and 60 hours.

Substrate22may be coated with single or multiple coating layers of the polymer, depending on, for example, the amount of hemostatic agent24to be delivered and desired release rate. Each layer of the polymer may contain the same or different amounts of hemostatic agent24. For example, a first layer of the polymer may contain hemostatic agent24, while the second layer of the polymer contains either no hemostatic agent24or a lower concentration of hemostatic agent24. As another example, a first layer of the polymer may comprise hemostatic agent24in a first polymer, while the second layer of the polymer comprises hemostatic agent24in a second polymer that is different than the first polymer.

In embodiments discussed herein wherein anchorage device20is a planar sheet, a first polymer can be applied to the top surface of the sheet and a second polymer can be applied to the bottom surface of the sheet. In some embodiments, the first and second polymers are different polymers. In some embodiments, the first and second polymers release hemostatic agent24at different rates and/or over different lengths of time. In some embodiments, the first and second polymers are different polymers, and the first polymer includes a first amount of hemostatic agent24and the second polymer includes a second amount of hemostatic agent24, the first amount being different than the second amount. In some embodiments, the first and second polymers are the same polymer, wherein the first polymer includes a first amount of hemostatic agent24and the second polymer includes a second amount of hemostatic agent24, the first amount being different than the second amount.

In embodiments discussed herein wherein anchorage device20is a pocket or envelope, a first polymer can be applied to first piece22aand a second polymer can be applied to second piece22b. In some embodiments, the first and second polymers are different polymers. In some embodiments, the first and second polymers release hemostatic agent24at different rates and/or over different lengths of time. In some embodiments, the first and second polymers are different polymers, and the first polymer includes a first amount of hemostatic agent24and the second polymer includes a second amount of hemostatic agent24, the first amount being different than the second amount. In some embodiments, the first and second polymers are the same polymer, wherein the first polymer includes a first amount of hemostatic agent24and the second polymer includes a second amount of hemostatic agent24, the first amount being different than the second amount. In some embodiments, a first polymer is applied to the outer surfaces of first and second pieces22a,22band a second polymer is applied to the inner surfaces of first and second pieces22a,22b, wherein the first polymer includes a first amount of hemostatic agent24and the second polymer includes a second amount of hemostatic agent24, the first amount being different than the second amount. In some embodiments, the first amount is more than the second amount. In some embodiments, the first amount is less than the second amount.

Active Pharmaceutical Ingredient(s)

In some embodiments, anchorage device20includes an ingredient, such as, for example, an active pharmaceutical ingredient26. Active pharmaceutical ingredient26is applied to substrate22to such that anchorage device20delivers hemostatic agent24in combination with active pharmaceutical ingredient26. In some embodiments, active pharmaceutical ingredient26is applied directly to substrate22. That is, active pharmaceutical ingredient26is not applied to substrate22in a polymer, such as, for example, a polymer that includes active pharmaceutical ingredient26. In some embodiments, active pharmaceutical ingredient26is applied to substrate22via a polymer, such as, for example, one of the polymers discussed herein, wherein the polymer includes active pharmaceutical ingredient26and releases active pharmaceutical agent26as the polymer degrades. In some embodiments, active pharmaceutical ingredient26is applied to substrate22via a polymer that includes hemostatic agent24. In some embodiments, active pharmaceutical ingredient26is applied to substrate22via a polymer that does not include hemostatic agent24, such as, for example, a polymer that is free of hemostatic agent24.

Active pharmaceutical ingredient26can include one or a combination of active pharmaceutical ingredients, such as, for example, anesthetics, antibiotics, anti-inflammatory agents, procoagulant agents, fibrosis-inhibiting agents, anti-scarring agents, antiseptics, leukotriene inhibitors/antagonists, cell growth inhibitors and mixtures thereof. In some embodiments, active pharmaceutical ingredient26is an antibiotic. In some embodiments, the antibiotic is selected from the group consisting of rifampin and minocycline and mixtures thereof.

Examples of anesthetics include, but are not limited to, licodaine, bupivacaine, and mepivacaine. Further examples of analgesics, anesthetics and narcotics include, but are not limited to acetaminophen, clonidine, benzodiazepine, the benzodiazepine antagonist flumazenil, lidocaine, tramadol, carbamazepine, meperidine, zaleplon, trimipramine maleate, buprenorphine, nalbuphine, pentazocain, fentanyl, propoxyphene, hydromorphone, methadone, morphine, levorphanol, and hydrocodone. Local anesthetics have weak antibacterial properties and can play a dual role in the prevention of acute pain and infection.

When a mixture of two antibiotics are used, they generally present in a ratio ranging from about 10:1 to about 1:10. In some embodiments, a mixture of rifampin and minocycline are used. In those embodiments, a ratio of rifampin to minocycline ranges from about 5:2 to about 2:5. In other embodiments, the ratio of rifampin to minocycline is about 1:1.

In some embodiments, active pharmaceutical ingredient26includes one or more ingredients that act as angiogenensis inhibitors or inhibit cell growth such as epidermal growth factor, PDGF, VEGF, FGF (fibroblast growth factor) and the like. These ingredients include anti-growth factor antibodies (neutrophilin-1), growth factor receptor-specific inhibitors such as endostatin and thalidomide. Examples of useful proteins include cell growth inhibitors such as epidermal growth factor.

Examples of leukotriene inhibitors/antagonists include, but are not limited to, leukotriene receptor antagonists such as acitazanolast, iralukast, montelukast, pranlukast, verlukast, zafirlukast, and zileuton.

In some embodiments, active pharmaceutical ingredient26includes sodium 2-mercaptoethane sulfonate (“MESNA”). MESNA has been shown to diminish myofibroblast formation in animal studies of capsular contracture with breast implants [Ajmal et al. (2003) Plast. Reconstr. Surg. 112:1455-1461] and may thus act as an anti-fibrosis agent.

Procoagulants include, but are not limited to, zeolites, thrombin, and coagulation factor concentrates.

In some embodiments, the amount of active pharmaceutical ingredient26that is applied to substrate22ranges between about 0.3 to about 2.8 micrograms/cm2. In other embodiments, the amount of active pharmaceutical ingredient26that is applied to substrate22ranges between about 0.6 to about 1.4 micrograms/cm2. In yet other embodiments, the amount of active pharmaceutical ingredient26that is applied to substrate22ranges between about 0.85 to about 1.20 micrograms/cm2. In yet further embodiments, the amount of active pharmaceutical ingredient26that is applied to substrate22ranges between about 0.90 to about 1.10 micrograms/cm2. In yet further embodiments, the amount of active pharmaceutical ingredient26that is applied to substrate22ranges between about 50 to about 150 micrograms/cm2. In yet further embodiments, the amount of active pharmaceutical ingredient26that is applied to substrate22ranges between about 62 to about 140 micrograms/cm2. In yet further embodiments, 62 micrograms/cm2of active pharmaceutical ingredient26is applied to substrate22. In yet further embodiments, 140 micrograms/cm2of active pharmaceutical ingredient26is applied to substrate22.

In other embodiments, active pharmaceutical ingredient26includes rifampin and minocycline and the amount of each of rifampin and minocycline that is applied to substrate22ranges between about 0.6 to about 1.4 micrograms/cm2. In yet other embodiments, the amount of each of rifampin and minocycline that is applied to substrate22ranges between about 0.85 to about 1.20 micrograms/cm2. In yet further embodiments, the amount of each of rifampin and minocycline that is applied to substrate22ranges between about 0.90 to about 1.10 micrograms/cm2.

Active pharmaceutical agent26may include any of the active pharmaceutical ingredients discussed herein. Active pharmaceutical agent26may be incorporated into anchorage device20by applying active pharmaceutical ingredient26directly to substrate22or by applying active pharmaceutical ingredient26to substrate22via a polymer, such as, for example, one or more of the polymers discussed herein. Doses of the active pharmaceutical ingredients discussed herein are known and the amounts of any single active pharmaceutical ingredient to include in anchorage device20can readily be surmised. Any pharmaceutically acceptable form of the active pharmaceutical ingredients discussed herein can be employed in anchorage device20, e.g., the free base or a pharmaceutically acceptable salt or ester thereof. Pharmaceutically acceptable salts, for instance, include sulfate, lactate, acetate, stearate, hydrochloride, tartrate, maleate, citrate, phosphate and the like.

In some embodiments, active pharmaceutical ingredient26is applied directly to substrate22, as discussed herein. In some embodiments, active pharmaceutical ingredient26may be applied to substrate22by spraying active pharmaceutical ingredient26onto substrate22, coating all or a portion of substrate22with active pharmaceutical ingredient26, coating all or a portion of substrate22with a material, such as, for example, one or more polymer that includes active pharmaceutical ingredient26, washing substrate22with active pharmaceutical ingredient26, or printing active pharmaceutical ingredient26on substrate22with a printer, such as, for example a 3D printer. In some embodiments, active pharmaceutical ingredient26is a material that forms substrate22. That is, substrate22is made from active pharmaceutical ingredient26and hemostatic agent24is applied to substrate22.

In some embodiments, active pharmaceutical ingredient26is positioned between hemostatic agent24and substrate22, as shown inFIG. 4. As such, hemostatic agent24forms a top layer of anchorage device20and is eluted or released before active pharmaceutical agent26is eluted or released. That is, active pharmaceutical agent26is eluted or released after all of hemostatic agent24is eluted or released. In some embodiments, substrate22is made from hemostatic agent24and active pharmaceutical ingredient26is applied to substrate22, as shown inFIG. 5. In some embodiments, hemostatic agent24is positioned between active pharmaceutical ingredient26and substrate22. As such, active pharmaceutical ingredient26forms a top layer of anchorage device20and is eluted or released before active hemostatic agent24is eluted or released. That is, hemostatic agent24is eluted or released after all of active pharmaceutical ingredient26is eluted or released.

In embodiments discussed herein wherein anchorage device20is a planar sheet, active pharmaceutical ingredient26can be applied to at least one of the top and bottom surfaces of the sheet. That is, active pharmaceutical ingredient26may be applied to both the top and bottom surfaces, or only one of the top and bottom surfaces. In some embodiments, a first active pharmaceutical ingredient26is applied to the top surface and a second active pharmaceutical ingredient26is applied to the bottom surface, wherein the first active pharmaceutical ingredient26is different than the second active pharmaceutical ingredient26. In some embodiments, a first active pharmaceutical ingredient26is applied to the top surface and a second active pharmaceutical ingredient26is applied to the bottom surface, wherein the first active pharmaceutical ingredient26includes a different amount of active pharmaceutical ingredient26than the second active pharmaceutical ingredient26.

In embodiments discussed herein wherein anchorage device20is a planar sheet, active pharmaceutical ingredient26can be applied to the top surface and hemostatic agent24can be applied to the bottom surface. In some embodiments, one of the top and bottom surfaces includes active pharmaceutical ingredient26and hemostatic agent24and the other of the top and bottom surfaces includes only hemostatic agent24. In some embodiments, one of the top and bottom surfaces includes active pharmaceutical ingredient26and hemostatic agent24and the other of the top and bottom surfaces includes only active pharmaceutical ingredient26. In some embodiments, one of the top and bottom surfaces includes active pharmaceutical ingredient26and hemostatic agent24and the other of the top and bottom surfaces does not include hemostatic agent24or active pharmaceutical ingredient26.

In embodiments discussed herein wherein anchorage device20is a planar sheet, a first polymer can be applied to one of the top and bottom surfaces and a second polymer can be applied to the other one of the top and bottom surfaces. In some embodiments, the first polymer includes hemostatic agent24and the second polymer includes active pharmaceutical ingredient26. In some embodiments, one of the first and second polymers includes hemostatic agent24and active pharmaceutical ingredient26and the other of the first and second polymers includes only hemostatic agent24. In some embodiments, one of the first and second polymers includes hemostatic agent24and active pharmaceutical ingredient26and the other of the first and second polymers includes only active pharmaceutical ingredient26. In some embodiments, one of the first and second polymers includes hemostatic agent24and active pharmaceutical ingredient26and the other of the first and second polymers does not include hemostatic agent24or active pharmaceutical ingredient26. In some embodiments, at least one of the first and second polymers includes a plurality of discrete layers, such as, for example, a first layer, a second layer, a third layer, a fourth layer, a fifth layer, etc. In some embodiments, at least one of the layers includes a polymer that is different than a polymer that forms at least one of the other layers.

In some embodiments, the layers each include the same polymer. In some embodiments, the contents of the layers alternate. For example, in some embodiments, the first layer includes hemostatic agent24, the second layer includes active pharmaceutical agent26, the third layer includes hemostatic agent24, the fourth layer includes active pharmaceutical agent26and the fifth layer includes hemostatic agent24, wherein the layers that include hemostatic agent24do not include active pharmaceutical ingredient26and the layers that include active pharmaceutical ingredient26do not include hemostatic agent24. In some embodiments, the layers each include hemostatic agent24, wherein the amount of hemostatic agent24in each layer is the same or different. In some embodiments, the layers each include active pharmaceutical agent26, wherein the amount of active pharmaceutical agent26in each layer is the same or different. In some embodiments, the layers each include hemostatic agent24and active pharmaceutical agent26, wherein the amount of hemostatic agent24and/or active pharmaceutical agent26in each layer is the same or different.

In embodiments discussed herein wherein anchorage device20is a pocket or envelope, active pharmaceutical ingredient26can be applied to at least one of first piece22aand second piece22b. In some embodiments, only one of first and second pieces22a,22bincludes active pharmaceutical ingredient26. In some embodiments, active pharmaceutical ingredient26is applied only to the outer surfaces of first and second pieces22a,22b. That is, the inner surfaces of first and second pieces22a,22bthat define cavity C do not have active pharmaceutical ingredient26applied thereto. In some embodiments, active pharmaceutical ingredient26is applied only to the inner surfaces of first and second pieces22a,22b. That is, the outer surfaces of first and second pieces22a,22bdo not have active pharmaceutical ingredient26applied thereto. In some embodiments, active pharmaceutical ingredient26is applied only to the inner surface of one of first and second pieces22a,22band to the outer surface of the other one of first and second pieces22a,22b.

In embodiments discussed herein wherein anchorage device20is a pocket or envelope, a first active pharmaceutical ingredient26can be applied to first piece22aand a second active pharmaceutical ingredient26can be applied to second piece22b, wherein the second active pharmaceutical ingredient26is different than the first active pharmaceutical ingredient26. In some embodiments, a first active pharmaceutical ingredient26is applied to the outer surfaces of first and second pieces22a,22band a second active pharmaceutical ingredient26is applied to the inner surfaces of first and second pieces22a,22b, wherein the second active pharmaceutical ingredient26is different than the first active pharmaceutical ingredient26.

In embodiments discussed herein wherein anchorage device20is a pocket or envelope, a first polymer can be applied to one of first and second pieces22a,22band a second polymer can be applied to the other one of first and second pieces22a,22b. In some embodiments, the first and second polymers are the same polymer. In some embodiments, the first and second polymers are different polymers. In some embodiments, the first and second polymers each include hemostatic agent24and active pharmaceutical ingredient26, wherein one of the first and second polymers includes more of hemostatic agent24than the other of the first and second polymers and the polymer that includes more of hemostatic agent24includes less of active pharmaceutical agent26than the other polymer. In some embodiments, the first polymer includes hemostatic agent24and the second polymer includes active pharmaceutical ingredient26. In some embodiments, one of the first and second polymers includes hemostatic agent24and active pharmaceutical ingredient26and the other of the first and second polymers includes only hemostatic agent24. In some embodiments, one of the first and second polymers includes hemostatic agent24and active pharmaceutical ingredient26and the other of the first and second polymers includes only active pharmaceutical ingredient26. In some embodiments, one of the first and second polymers includes hemostatic agent24and active pharmaceutical ingredient26and the other of the first and second polymers does not include hemostatic agent24or active pharmaceutical ingredient26.

In some embodiments, at least one of the first and second polymers includes a plurality of discrete layers, such as, for example, a first layer, a second layer, a third layer, a fourth layer, a fifth layer, etc. In some embodiments, the layers each include different polymers. In some embodiments, the layers each include the same polymer. In some embodiments, the contents of the layers alternate. For example, in some embodiments, the first layer includes hemostatic agent24, the second layer includes active pharmaceutical agent26, the third layer includes hemostatic agent24, the fourth layer includes active pharmaceutical agent26and the fifth layer includes hemostatic agent24, wherein the layers that include hemostatic agent24do not include active pharmaceutical ingredient26and the layers that include active pharmaceutical ingredient26do not include hemostatic agent24. In some embodiments, the layers each include hemostatic agent24, wherein the amount of hemostatic agent24in each layer is the same or different. In some embodiments, the layers each include active pharmaceutical agent26, wherein the amount of active pharmaceutical agent26in each layer is the same or different. In some embodiments, the layers each include hemostatic agent24and active pharmaceutical agent26, wherein the amount of hemostatic agent24and/or active pharmaceutical agent26in each layer is the same or different.

In embodiments discussed herein wherein anchorage device20is a pocket or envelope, a first polymer can be applied to first piece22aand a second polymer can be applied to second piece22b. In some embodiments, the first and second polymers are different polymers. In some embodiments, the first and second polymers release hemostatic agent24and/or active pharmaceutical agent26at different rates and/or over different lengths of time. In some embodiments, the first and second polymers are different polymers, and the first polymer includes a first amount of hemostatic agent24and/or active pharmaceutical agent26and the second polymer includes a second amount of hemostatic agent24and/or active pharmaceutical agent26, the first amount being different than the second amount. In some embodiments, the first and second polymers are the same polymer, wherein the first polymer includes a first amount of hemostatic agent24and/or active pharmaceutical agent26and the second polymer includes a second amount of hemostatic agent24and/or active pharmaceutical agent26, the first amount being different than the second amount.

In some embodiments, a first polymer is applied to the outer surfaces of first and second pieces22a,22band a second polymer is applied to the inner surfaces of first and second pieces22a,22b, wherein the first polymer includes a first amount of hemostatic agent24and/or active pharmaceutical agent26and the second polymer includes a second amount of hemostatic agent24and/or active pharmaceutical agent26, the first amount being different than the second amount. In some embodiments, the first amount is more than the second amount. In some embodiments, the first amount is less than the second amount.

In some embodiments, hemostatic agent24and/or active pharmaceutical ingredient26is/are configured to elute/release from anchorage device20into an area surrounding or adjacent to anchorage20to reduce or stop bleeding and/or reduce the amount of associated post-surgical complications that can occur with such implantable medical devices, such as, for example, post-implant infection, pain, excessive scar tissue formation and shrinkage of the prosthesis or mesh, excessive scar tissue formation, limited patient mobility, and/or chronic pain.

In some embodiments, hemostatic agent24and/or active pharmaceutical ingredient26is configured to elute/release from anchorage device20into an area surrounding or adjacent to anchorage20to reduce or stop bleeding and/or reduce or prevent surgery-related complications associated with the implantable medical device (such as to the “pocket” surrounding the device). For example, an anesthetic agent can be eluted into the surrounding bodily tissue, bodily fluid, or systemic fluid, to attenuate pain experienced at the implantation site. In another example, replacing the anesthetic agent with an anti-inflammatory agent can reduce the swelling and inflammation associated implantation of the mesh substrate and/or the implantable medical device. In yet another example, an antimicrobial agent can be provided at a rate of drug release sufficient to prevent or reduce colonization of substrate22, the implantable medical device and/or the surgical implantation site by bacteria, for example, for at least the period following surgery necessary for initial healing of the surgical incision.

In some embodiments, hemostatic agent24and/or active pharmaceutical ingredient26may be eluted for up to 30 days. In some embodiments, between about 40% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 30 hours. In some embodiments, 60% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 30 hours. In some embodiments, between about 65% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 36 hours. In some embodiments, 80% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 36 hours. In some embodiments, between about 60% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 48 hours. In some embodiments, 80% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 48 hours. In some embodiments, between about 60% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 60 hours. In some embodiments, 80% and about 100% of hemostatic agent24and/or active pharmaceutical ingredient26is/are released over a period of at least about 60 hours.

In some embodiments, anchorage device20includes a hydrophilic component, such as, for example, PEG and a crosslinking agent that is applied to substrate22. The hydrophilic component and the crosslinking agent form a hydrogel that absorbs blood and reduces bleeding when in contact with blood or tissue fluid. In some embodiments, the hydrophilic component and the crosslinking agent are sprayed directly onto substrate22. In some embodiments, the hydrophilic component and the crosslinking agent are provided in a polymer, such as, for example, one or more of the polymers discussed herein, and the polymer is applied directly onto substrate22. In some embodiments, the hydrophilic component and the crosslinking agent are provided in a patch, such as, for example, the Veriset™ hemostatic patch available from Medtronic, Inc., and the patch is applied directly onto substrate22. In some embodiments, the patch comprises a plurality of layers. For example, a first layer of the patch can include a hemostatic agent, such as, for example, oxidized regenerated cellulose and/or one or more of the hemostatic agents discussed herein. A second layer of the patch can include a crosslinking agent, such as, for example, trilysine and/or one or more of the crosslinking agents discussed herein. A third layer of the patch can include a hydrophilic agent, such as, for example, PEG and/or one or more of the hydrophilic agents discussed herein. The second layer of the patch is positioned between the first and third layers of the patch.

In some embodiments, the hydrophilic component comprises thermogelling hydrogels, PEG-PLGA copolymers, PEG -Poly(N-isopropyl acrylamide), Pluronic (PEO-PPO-PEO triblock), PEG-PCL polymers, PEG-based amphiphilic copolymers modified by anionic weak polyelectrolytes, (such as polyacrylic acid, polyglutamic acid) and polymers containing sulfonamide groups), PEG-based amphiphilic copolymers modified by cationic weak polyelectrolytes (such as poly (2-vinyl pyridine), Poly(beta-amino esters), poly (2-(dimethylamino)ethyl methacrylate), multiarm PEG derivatives such as those available from JenKem technology, multiarmed block and graft PLA copolymers with PEG, PEG with stereo complexed poly(lactide), acrylated polymers (such as Polyvinylalcohol, dextran, Polyvinylpyrollidone, chitosan, alginate, hyaluronic acid), and combinations thereof. In some embodiments, the crosslinking agent comprises one or more agents that induce polymerization of vinyl groups using various initiators, light or redox reactions, or by reactions such as Schiff base formation, Michael type additions, peptide ligation, clock chemistry of functional groups present; one or more agents that induce crosslinking by enzymatic reaction (transglutaminase mediated reaction between carboxamide and amine on proteins), stereo-complexation, metal chelation (alginates using calciumCal2), thermogelation, self-assembly (formation of super helices from protein chains) inclusion complexation (using cyclodextrin); and combinations thereof.

Methods

In some embodiments, an anchorage device, such as, for example, anchorage device20and a medical device, such as, for example, one of the implantable medical devices discussed herein are implanted into a body of a patient. The anchorage device releases a hemostatic agent, such as, for example, hemostatic agent24to reduce or prevent bleeding within the patient. In some embodiments, the anchorage device also releases an active pharmaceutical agent, such as, for example, active pharmaceutical ingredient26to prevent, mitigate, or treat a condition within the patient, such as, for example, a bacterial infection. In some embodiments, the anchorage device releases the hemostatic agent before the active pharmaceutical ingredient. In some embodiments, the anchorage device releases the hemostatic agent after the active pharmaceutical ingredient. In some embodiments, the anchorage device releases the hemostatic agent and the active pharmaceutical ingredient simultaneously. In some embodiments, the anchorage device releases the hemostatic agent and/or the active pharmaceutical ingredient upon implantation of the anchorage device. In some embodiments, the anchorage device releases the hemostatic agent and the active pharmaceutical ingredient in alternating sequences. In some embodiments, the anchorage device is implanted within the patient without the medical device and the medical device is coupled to or inserted into the anchorage device after the anchorage device is implanted. In some embodiments, the medical device is coupled to or inserted into the anchorage device before the anchorage device is implanted within the patient and the anchorage device and the medical device are implanted within the patient together.

In some embodiments, the implantable medical device is removed from the patient after the treatment is completed. In some embodiments, the anchorage device remains implanted within the patient after the implantable medical device is removed. In some embodiments, the anchorage device is removed from the patient after the implantable medical device is removed. To remove the anchorage device, tissue that is ingrown within the substrate of the anchorage device can be cut or otherwise detached from the substrate. In some embodiments, a portion of the anchorage device may not be removable from the tissue and will remain implanted within the patient.

In some embodiments, kits are provided that include one or a plurality of anchorage devices, such as, for example, anchorage devices20. It is contemplated that each of the anchorage devices included can have a different configuration. In some embodiments, the anchorage devices can include different hemostatic agents, such as, for example, hemostatic agent24and/or different active pharmaceutical ingredients, such as, for example, different active pharmaceutical ingredients26. In some embodiments, the anchorage devices can include different amounts of a hemostatic agent, such as, for example, hemostatic agent24and/or different amounts of an active pharmaceutical ingredient, such as, for example, different active pharmaceutical ingredients26. In some embodiments, the anchorage devices can include different sizes. In some embodiments, the anchorage devices can include different shapes. In some embodiments, the anchorage devices can include different anchorage devices that are designed for use with different medical devices, such as, for example, the implantable or non-implantable medical devices discussed herein. In some embodiments, the kits include one or a plurality of medical devices, such as, for example, the implantable or non-implantable medical devices discussed herein. In some embodiments, the kit includes instructions for use.

In one example, an anchorage device having a substrate, such as, for example, one of the substrates discussed above was prepared. 5 g of Chitosan (HMW, Sigma MKBP1333V) was dissolved in a mixture of 460 mL distilled water and 40 mL1M HCl. 10 mL of the viscous solution was poured into a Teflon petri dish and placed in a hood. After 24 h, the composition was dry to touch. It was then placed in a 50° C. oven under vacuum for 24 h. An equivalent procedure was used to prepare substrates from other materials. Details are given in Table A below.

In another example, a hemostatic coated mesh substrate was prepared. A knitted multifilament mesh was taped down on a flat Teflon sheet. Prepared hemostat solutions described above were poured onto the mesh and spread using a Gardner Knife. The compositions were allowed to dry overnight in the hood and then at 50° C. under vacuum for 24 hours. Chitosan and PVP solutions and a 1:1 mixture of Chitosan and PVP were used to prepare hemostat coated meshes.

Hemostatic properties of the anchorage devices prepared in Examples 1 and 2 were observed. Water absorption was used as the initial screening test for hemostatic properties. A commercial hemostat Surgifoam was used as the control. Not wetted Surgifoam does not soak water easily, but wetted one works as a sponge. A piece of the hemostatic composition was placed on a flat Teflon surface. 3 drops of water were placed in the center of the composition and the time for water to absorb and the physical state of the hemostats were observed. Results are shown inFIG. 24.

In another example, an anchorage device was prepared wherein the anchorage device had an active pharmaceutical ingredient, such as, for example, at least one antimicrobial agent was applied to a substrate, such as for example, a hemostatic mesh. A sheet of organic regenerated cellulose (ORC) made from multifilament fibers was stretched over a rectangular frame (10 inches×13 inches). This was coated with a 4% Weight by volume solution containing Rifampin, minocycline and tyrosine polyarylate (15:15:70 by weight) dissolved in THF:Methanol (9:1 VN) using an ultrasonic spraying machine (Ultrasonic Systems, Inc., Haverhill, Mass.). The coated mesh was dried under vacuum for 24 h at 50 C.

In another example, an agent, such as, for example, at least one of the active pharmaceuticals discussed herein was selectively applied to a substrate of an anchorage device. Different patterns were created on an ORC sheet (made from multifilament fibers) by masking predetermined areas of the mesh with masking tape. The patterned sheet of ORC was stretched over a rectangular frame (10 inches×13 inches). This was coated with a 4% Weight by volume solution containing Rifampin, minocycline and tyrosine polyarylate (15:15:70 by weight) dissolved in THF:Methanol (9:1 VN) using an ultrasonic spraying machine (Ultrasonic Systems, Inc., Haverhill, Mass.). The coated mesh was dried under vacuum for 24 h at 50 C. The masking tape was peeled off to create meshes with the predetermined pattern.

In another example, an anchorage device having a configuration of a pocket, pouch or envelope discussed above was prepared. Two sheets of the coated synthetic mesh were coated mesh placed one on top of the other and sealed and cut into the shape using an ultrasonic weld. The anvil used in the ultrasonic welding resulted in the formation of a pouch 2.5″×2.75″ in size, sealed on approximately 3 and one-half sides. By changing the size and shape of the anvil, pouches of different sizes and shapes can be made.

In another example, an agent, such as, for example, at least one of the hemostatic agents discussed herein was prepared to be applied to a substrate of an anchorage device, such as, for example, one of the substrates discussed herein. A 5% solution of chitosan (Aldrich, low molecular weight) was prepared as follows. 5 g of chitosan, 2.5 g of succinic acid were added to 100 mL of distilled water in a 250-mL glass jar containing a magnetic stir bar. The mixture was stirred at 500 rpm until a clear viscous solution was obtained.

In another example, an agent, such as, for example, at least one of the hemostatic agents discussed herein was applied to a substrate of an anchorage device, such as, for example, one of the pockets, pouches or envelopes discussed herein. A piece of Tyvek (blown PTFE) film (size equal to that of the inner dimensions of the envelope) was placed within the envelope. The envelope was placed on a flat sheet of Teflon. About 10 mL of the hemostat solution was poured on the envelope and spread using a polypropylene rod. After drying for 24 hours under the hood, the envelope was removed, excess hemostat was trimmed off and the inner Teflon sleeve was removed. This resulted in the hemostatic agent being applied to one side of the envelope. That is, the other side of the envelope did not include the hemostatic agent.

In another example, an agent, such as, for example, at least one of the hemostatic agents discussed herein was applied to a substrate of an anchorage device, such as, for example, one of the pockets, pouches or envelopes discussed herein. The envelope was mounted on a plastic mandrel, which was then dipped into the viscous solution of hemostat. Excess solution was allowed to drain. The mandrel was dried under vacuum at 80 C for 36 hours. After cooling, the envelope was removed from the mandrel. This resulted in the hemostatic agent being applied to both sides of the envelope.

In another example, an anchorage device having a configuration of a pocket, pouch or envelope discussed above was prepared. The envelopes were made from one or more sheets comprising a hemostatic agent and a mesh material that is coated with an antibiotic, such as, for example at least one of the antibiotics discussed herein. The devices may be created from hemostatic sheets and synthetic mesh by fusing them using heat, ultrasonic energy or solvent, polymeric solutions or glue, as discussed below.

1. In one example, two sheets of ORC mesh coated with tyrosine polymer plus Rifampin and Minocycline were placed within the jaws of a PACWORLD bar sealer (using the following conditions: 7 Sec, 140 C, 80 psi. The sheets were fused together, as discussed herein, and shown inFIG. 25.

2. In one example, one sheet of ORC mesh coated with tyrosine polymer, Rifampin and Minocycline and one sheet of biodegradable mesh made from glycolide, caprolactone and trimethylene carbonate coated with tyrosine polymer with Rifampin and Minocycline were placed within the jaws of a PACWORLD bar sealer (using the following conditions: 7 Sec, 140 C, 80 psi. The sheets were fused together, as discussed herein and shown inFIG. 26.

3. In one example, one sheet of uncoated ORC mesh and one sheet of biodegradable mesh made from glycolide, caprolactone and trimethylene carbonate coated with tyrosine polymer with Rifampin and Minocycline were placed within the jaws of a PACWORLD bar sealer (using the following conditions: 7 Sec, 140 C, 80 psi. The sheets were fused together, as discussed herein and shown inFIG. 27.

4. In one example, one sheet of coated ORC mesh coated with tyrosine polymer plus Rifampin and Minocycline in a pattern and one sheet of biodegradable mesh made from glycolide, caprolactone and trimethylene carbonate coated with tyrosine polymer with Rifampin and Minocycline in a pattern were placed within the jaws of a PACWORLD bar sealer (using the following conditions: 7 Sec, 140 C, 80 psi. The sheets were fused together, as discussed herein. The pattern on the ORC mesh sheet is shown inFIG. 28.

Solvent Based

5. In one example, a solution of tyrosine polymer was placed between two sheets of uncoated ORC. The sheets were clamped together. After drying for 36 h under ambient conditions, it was further dried at 80 C for 24 hours. The sheets were fused together, as discussed herein.

6. In one example, two sheets of polymer coated ORC were wetted with DMSO. The sheets were clamped together. After drying for 36 h under ambient conditions, it was further dried at 80 C for 24 hours. The sheets were fused together, as discussed herein.

7. In one example, two sheets of polymer coated ORC was wetted with DMF. The sheets were clamped together. After drying for 36 h under ambient conditions, it was further dried at 80 C for 24 hours. The sheets were fused together, as discussed herein.

Adhesive

8. In one example, a small amount of cyanoacrylate glue was placed between two sheets of uncoated ORC. The sheets were clamped together and dried at room temperature for 1 hour. The sheets were fused together, as discussed herein.

Sewing

9. In one example, two sheets of ORC mesh coated with tyrosine polymer plus Rifampin and Minocycline were sewn together

10. In one example, one sheet of ORC mesh coated with tyrosine polymer, Rifampin and Minocycline and one sheet of biodegradable mesh made from glycolide, caprolactone and trimethylene carbonate coated with tyrosine polymer with Rifampin and Minocycline were sewn together

11. In one example, one sheet of uncoated ORC mesh and one sheet of biodegradable mesh made from glycolide, caprolactone and trimethylene carbonate coated with tyrosine polymer with Rifampin and Minocycline were sewn together

12. In one example, one sheet of coated ORC mesh coated with tyrosine polymer plus Rifampin and Minocycline in a pattern and one sheet of biodegradable mesh made from glycolide, caprolactone and trimethylene carbonate coated with tyrosine polymer with Rifampin and Minocycline in a pattern were sewn together.

13. In one example, one sheet of uncoated ORC mesh and one sheet of biodegradable film made from tyrosine polymer with Rifampin and Minocycline were sewn together.

14. In one example, one sheet of ORC mesh coated with tyrosine polymer plus Rifampin and Minocycline and one sheet of biodegradable film made from tyrosine polymer with Rifampin and Minocycline were sewn together were sewn together.

In another example, an agent, such as, for example, at least one of the hemostatic agents discussed herein was selectively applied to a substrate of an anchorage device. A sheet of biodegradable mesh made from glycolide, caprolactone and trimethylene carbonate coated with tyrosine polymer with Rifampin and Minocycline was fixed to a flat surface. Drops of a solution of Chitosan (5% w/v) in water containing succinic acid was applied to the mesh using a syringe. The mesh was dried overnight at room temperature and then at 80° C. under vacuum for 24 h.

In another example, agents, such as, for example, at least one of the hemostatic agents discussed herein and at least one of the active pharmaceutical ingredients discussed herein were selectively applied to a substrate of an anchorage device. A 4% Weight by volume solution containing Rifampin, minocycline and tyrosine polyarylate (15:15:70 by weight) dissolved in THF:Methanol (9:1 VN) was first prepared. Fine particles of a suitable hemostatic agent were suspended in this mixture and the suspension was sprayed onto a suitable mesh substrate. After drying under ambient condition until the coating was dry to the touch, the mesh was dried in a vacuum oven at 80° C. for 24 to 72 hours. The hemostatic agents can be selected from any of the hemostatic agents discussed herein and/or tranexamic acid, amino caproic acid (e.g., epsilon amino caproic acid), aprotinin, natural serine protease inhibitors, or polymers such as ORC or chitosan or other polysaccharides. In some embodiments, the hemostatic agents can include Arista AH hemostat and a desiccant. In some embodiments, the Arista AH hemostat is a hydrophilic, flowable, sterile, fine, dry white powder made by crosslinking purified plant starch through a proprietary process into Microporous Polysaccharide Hemispheres (MPH). In some embodiments, the hemostatic agents can include those discussed by Barnard J, Millner R, “A Review of Topical Hemostatic Agents for Use in Cardiac Surgery,” Ann Thorac Surg. 2009, 88: 1377-1383. 10.1016, which is incorporated herein by reference, in its entirety. In some embodiments, the hemostatic agents can include those discussed by Jill Henley, Jerry D. Brewer, “Newer Hemostatic Agents Used in the Practice of Dermatologic Surgery,” Dermatology Research and Practice 2013, 1-15, which is incorporated herein by reference, in its entirety. In some embodiments, the hemostatic agents can include those discussed by F. I. Broekema, W. Van Oeveren, J. Zuidema, S. H. Visscher, and R. R. M. Bos, “In vitro analysis of polyurethane foam as a topical hemostatic agent,” Journal of Materials Science, vol. 22, no. 4, pp. 1081-1086, 2011, which is incorporated herein by reference, in its entirety.

In another example, anchorage devices having a substrate, such as, for example, one of the substrates discussed above were prepared wherein the substrate was made from fibers that include a hemostatic agent, such as, for example, at least one of the hemostatic agents discussed herein, and fibers that do not include a hemostatic agent. In one example, the fibers that include the hemostatic agent are made from an aqueous solution that include the hemostatic agent(s). In some embodiments, an active pharmaceutical ingredient is added to the aqueous solution. In one example, the fibers that do not include the hemostatic agent are coextruded with an active pharmaceutical ingredient, such as, for example, at least one of the active pharmaceutical ingredients discussed herein. The fibers are swelled in some solvent containing the API, such as, for example, polyurethane or silicone in THF. The fibers that include the hemostatic agent and the fibers that do not include the hemostatic agent are dried, and the dried fibers are used to form a mesh. In some embodiments, the fibers that include the hemostatic agent are made as discussed by Pillai, C. K. S.; Paul, W.; Sharma, C. P. Chitin and chitosan polymers: Chemistry, solubility and fiber formation. Prog. Polym. Sci. 2009, 34, 641-678, which is incorporated herein by reference, in its entirety.

In another example, an agent, such as, for example, at least one of the active pharmaceuticals discussed herein was applied to a substrate of an anchorage device such that the agent eluted or released from the substrate at a selected rate. The substrate was made from various combinations of Glycoprene®, ORC, polymer-coated Glycoprene® (e.g., one of the tyrosine-derived polymers discussed herein), and polymer-coated ORC (e.g., one of the tyrosine-derived polymers discussed herein). The samples were weighed in 20 mL scintillation vials and then immersed in 20 mL of phosphate buffered saline (pH 7.4). The vials were allowed to shake at 120 rpm in an incubator at 37° C. At various subsequent time points, 1 mL of the buffer was removed for analysis by UPLC. At each time point after 1 mL was removed, the buffer was decanted. The vials were replenished with fresh buffer and returned to the incubator. The volume of fresh buffer was gradually reduced from the initial 20 mL to 10 mL, 5 mL, and 2 mL in order to maintain a concentration that can be detected by UPLC.

Samples of coated ORC and coated Glycoprene® were weighed in 20 mL scintillation vials. Samples were initially dissolved in DMSO and allowed to shake for at least 15 minutes. Then, MeOH was added and vials were allowed to shake for another minimum of 15 minutes. One (1) mL of each solution was then filtered through a 0.45 micron PTFE filter and loaded onto the UPLC for analysis. Results below are reported as a cumulative % released against time.

Substrates, such as, for example, the substrates discussed herein, were prepared, as discussed herein, to include coatings (e.g., polymers) that elute an active pharmaceutical ingredient, such as, for example, at least one of the active pharmaceutical ingredients discussed herein, at different rates. Ten samples were produced (Samples 1-6 and 9-12), as shown inFIG. 29. In the data provided below, “Tyrx” or “TYRX” refers to a degradable polymer, and in particular, to one or more of the tyrosine-derived polymers discussed herein, wherein the polymer includes at least one active pharmaceutical ingredient.

The active pharmaceutical ingredient(s) or drug(s) in each of Samples 1-6 and 9-12 is shown inFIG. 30. Further details regarding the substrates used in Samples 1-6 and 9-12 are provided inFIG. 30A.

AIGIS-R refers to a resorbable mesh substrate that is coated with a polymer, such as, for example, one of the tyrosine-derived polymers discussed herein, wherein the polymer includes at least one active pharmaceutical ingredient, as shown below. In the samples that include Glycoprene®, the Glycoprene® is a mesh that forms the substrate. The elution rates of the active pharmaceutical ingredients in Samples 1-6 and 9-12 are shown in the elution profiles inFIGS. 31A-31T.

In this example, different substrates were examined to test and compare the elution profiles of the different substrates to determine the effect, if any, of combining polymer-coated substrates with uncoated substrates.

When uncoated Glycoprene® was added to coated ORC in samples 1 and 2, both minocycline and rifampin releases were below 20% after 2 hours. By 24 hours, minocycline release was above 60%, and rifampin release was over 20%. Minocycline and rifampin releases continued to increase between 24 and 30 hours.

With the addition of uncoated ORC to coated Glycoprene® in samples 3 and 4, more than 20% minocycline and 20% rifampin was released after 2 hours. After 6 hours, minocycline release was over 80% while rifampin release was over 60%.

Samples 5 and 6 consisted of both coated Glycoprene® and coated ORC. After 2 hours, minocycline release was over 20% while rifampin release was around 50%. By 6 hours, more than 60% of minocycline was released, and more than 20% of rifampin was released. After 24 hours, rifampin release was approximately 40% while minocycline release was over 70%. Minocycline and rifampin releases continued to increase between 24 and 30 hours.

Minocycline and rifampin elution from samples 9 and 10 (coated ORC) was below 20% after 2 hours. After 24 hours, minocycline release was over 60%, while rifampin release was over 20%. Minocycline and rifampin releases continued to increase between 24 and 30 hours.

For samples 11 and 12 of coated Glycoprene®, more than 80% minocycline and more than 60% rifampin was released in 2 hours. Minocycline and rifampin release rate gradually increased until it leveled off after 6 hours.

In samples 1-6 and 9-10 after 2 hours immersion in PBS, the ORC component can be visually observed to be swollen.

To determine the stability of active pharmaceutical ingredients, such as, for example, one or more of active pharmaceutical ingredients26when combined with a hemostatic agent, such as, for example, one or more of hemostatic agents24, mixtures of rifampin and minocycline were prepared in phosphate-buffered saline (PBS) with and without tranexamic acid (TXA). The mixtures were tested both at room temperature (RT) (about 23° C.) and at 37° C. As shown inFIG. 32, mixtures of rifampin and minocycline in PBS with and without tranexamic acid have substantially the same percentage area of rifampin and minocycline, thus indicating that tranexamic acid does not negatively affect the stability of rifampin and minocycline. In particular, the percentage area of rifampin was substantially the same for mixtures of rifampin and minocycline in PBS with and without tranexamic acid, regardless of the temperature; the percentage area minocycline was substantially the same for mixtures of rifampin and minocycline in PBS with and without tranexamic acid when the mixtures were at the same temperature.

To determine the elution of active pharmaceutical ingredients, such as, for example, one or more of active pharmaceutical ingredients26from a polymer, such as, for example, one of the polymers discussed herein, in vitro when the active pharmaceutical ingredients are combined with a hemostatic agent, such as, for example, one or more of hemostatic agents24, in vitro elution of rifampin and minocycline from polymers in the p22-27.5 family containing different amounts of tranexamic acid was evaluated in a PBS buffer over 25 hours. B1=PBS pH 7.4; B2=PBS, pH 7.4+TXA (0.05 mg/mL); B3=PBS, pH 7.4+TXA (5 mg/mL). The elution rates for rifampin and minocycline are shown inFIG. 33. As shown inFIG. 33, the elution rates of rifampin and minocycline were not affected by the presence of TXA in the release media.

To determine the sustained release of active pharmaceutical ingredients, such as, for example, one or more of active pharmaceutical ingredients26from a polymer, such as, for example, one of the polymers discussed herein, when the active pharmaceutical ingredients are combined with a hemostatic agent, such as, for example, one or more of hemostatic agents24, thin and thick solvent cast films containing rifampin (Rif) and tranexamic acid were prepared. Thin and thick solvent cast films containing minocycline (Min) and tranexamic acid were also prepared. The tranexamic acid phase was separated in each of the films. Thin films had a thickness of about 30 microns and thick films had a thickness of about 400 microns. Elution of rifampin and minocycline was measured over about 30 hours. The percentage of rifampin and minocycline released at 2 hours, 6 hours and 24 hours was recorded. As shown inFIG. 34, the thin films released rifampin and minocycline more quickly than the thick films at the same time intervals. However, for each set of films (thick and thin), rifampin and minocycline were shown to elute at similar rates.

Tests were conducted to compare the time required to induce blood clotting in vitro when different amounts of hemostatic agent is administered in the presence of TYRX (degradable mesh coated with P22-27.5 containing rifampin and minocycline), as shown inFIG. 35. Clotting time was increased when higher amounts of TXA was present (1.6 mg TXA vs 200 mg of TXA), as shown inFIG. 35A.

Tests were conducted to compare the time required for different hemostatic agents to induce blood clotting in vitro versus the time required to induce blood clotting in vitro when no hemostatic agent is administered. In particular, the time required to induce blood clotting was plotted for blood alone, TYRX), Surgicel, TYRX with 1.6 mg of TXA, 1.2 mg of TXA alone and TYRX with 200 mg of TXA. In this example, TYRX refers to a Glycoprene mesh that is coated with P22-27.5 (a polymer in the P22-X family) containing Rifampin and Minocycline. As shown inFIG. 36, blood alone and TYRX were both effective to induce blood clotting in about 14 minutes; Surgicel was effective to induce blood clotting in about 17 minutes; TYRX with 1.6 mg of TXA was effective to induce blood clotting in about 12 minutes; 1.2 mg of TXA alone was effective to induce blood clotting in about 19 minutes; and the p22-27.5 polymer having 200 mg of TXA was effective to induce blood clotting in about 32 minutes, thus indicating that TYRX with low amount of TXA (1.6 mg) may induce blood clotting better than TYRX with 200 mg TXA.

To determine the impact, if any, of a hemostatic agent, such as, for example, one or more of hemostatic agents24on bacterial attachment, three samples were prepared. The first sample included a TYRX polymer in the p22-xx family (P22-27.5-TYRX); the second sample included TYRX and tranexamic acid (TYRX+TXA); and the third sample included an extracellular matrix (ECM) to be used as a control. In this example, TYRX refers to a glycoprene mesh that is coated with P22-27.5 (a polymer in the P22-X family) containing rifampin and minocycline. The samples were each suspended in 3 mL of a Brain Heart Infusion (BHI) medium at 37° C. for 24 hours. The samples were each inoculated with 2× Colony Forming Units (CFU)/mL of a clinical strain of Methicillin-resistantStaphylococcus aureus(MRSA). After 24 hours, each of the samples was rinsed twice and bacterial attachment was visualized by Live/Dead staining and imaged with Leica DM RXE microscope attached to a TCS SP2 AOBS confocal system (Leica Microsystems, Exton, Pa.). As shown inFIG. 37, the TYRX and TYRX+T×A samples exhibited less bacterial attachment than the ECM control.

Example 20—Chitosan Solutions for Preparing Films

1 gram of Chitosan (Sigma) was added to 100 mL of Aqueous Acetic acid (1% Acetic acid). The mixture was stirred using a magnetic stir bar until no solids remained.

Films were cast by pouring on 10 mL of the chitosan solution onto a TEFLON sheet. The solution was covered with a Petri dish dried in a ventilated hood 24 hrs. The Petri dish was removed and the films dried for an addition 72 hrs. A transparent film was obtained.

50 mg of Tranexamic acid was added to 10 g of the chitosan solution prepared as described above in a 20-mL scintillation vial. The vial was capped and placed on a shaker. The contents were shaken for 1 hr, when all the TXA had dissolved.

Films were cast by pouring on to a TEFLON sheet. The solution was covered with a Petri dish dried in a ventilated hood 24 hrs. The Petri dish was removed and the films dried for an addition 72 hrs. A transparent red film was obtained.

50 mg of Tranexamic acid, 50 mg of Rifampin, 50 mg of Minocycline-HCL was added to 10 g of the chitosan solution prepared as described above in a 20-mL scintillation vial. The vial was capped and placed on a shaker. The contents were shaken for 1 hr, when all the drugs had had dissolved.

Films were cast by pouring on to a TEFLON sheet. The solution was covered with a Petri dish dried in a ventilated hood 24 hrs. The Petri dish was removed and the films dried for an addition 72 hrs. A transparent red film was obtained.

Two kinds of meshes were used in these experiments—a monofilament mesh of polypropylene (non-absorbable) and a multifilament absorbable mesh (GLYCOPRENE II), which is made from glycolide, caprolactone and trimethylene carbonate.

Strips of mesh approximately 1 cm×3 cm were hand dipped into the solutions of chitosan, Chitosan+Tranexamic acid and Chitosan+Tranexamic acid+Rifampin+Minocycline. HCl. These solutions were prepared as described above. Excess solution was removed using Kim wipes and wet strips were hung to dry in a hood. The coated meshes were dry to the touch after overnight drying.

Example 21—Avoiding Crystallization in Films

To assess how to avoid crystallization in films, four samples were prepared—sample J, sample L, sample B2 and sample F2. Sample J includes a polymer in the p22-xx family (P22-27.5-TYRX), rifampin, minocycline and tranexamic acid. Sample L includes a polymer in the p22-xx family (P22-27.5-TYRX), rifampin, minocycline, tranexamic acid and water. Sample B2 includes a polymer in the p22-xx family (P22-27.5-TYRX) and tranexamic acid. Sample F2 includes a polymer in the p22-xx family (P22-27.5-TYRX), tranexamic acid and water.

The samples were imaged using a digital microscope under a variety of illumination conditions and magnifications of 50×, 100×, and 200×. Transmitted crossed-polarized illumination highlighted anisotropic, apparently crystalline features in several films, as shown inFIG. 38.

Transmitted crossed-polarized illumination highlighted anisotropic, apparently crystalline features in films containing TXA. However, the apparently crystalline features were not observed in sample F2 or sample L, as shown inFIG. 38. Both of these samples were made with 1 mL aqueous TXA.

Example 22—Preparation of Electrospun Mats

Some of the properties of electro spun fibers are their high surface area, inherent 3 dimensional features and tunable porosity. In electro spinning, a thin stream of charged polymer solution is ejected from a spinneret in the presence of a high electric field (in the range of 105 to 106 V/m) applied between a conducting collector and the spinneret. Due to the application of electrostatic potential, the jet will stretch and whip around along with solvent evaporation because of the columbic repulsion between the surface charges. The resulting mass of fine fiber (nanofibers) is then collected on the target electrodes.

This technique can be used to molecules within the fiber matrix. If the drug is soluble in the polymer solution, then the drugs will be homogeneously distributed (dissolved) within the fiber. If however, the drug particles are not soluble in the polymer matrix, then the insoluble particles will be entrapped within the fiber matrix.

This technique can therefore be used to encapsulate water soluble active pharmaceutical ingredients and/or hemostatic agents (such as, for example tranexamic acid, peptides, proteins) which have poor solubility in organic solvents. Typically, a solution of the organic soluble active pharmaceutical ingredients and/or hemostatic agents with a particle size of less than 100 microns are suspended in an organic solution of a polymer and subjected to the electrospinning process, resulting in matrix of polymer fibers containing particles of drug. This technique is useful since high payloads of drugs can be incorporated into the substrate. The polymer solution may optionally contain other organic soluble compounds, including active pharmaceutical ingredients and/or hemostatic agents. More than one organic insoluble compound can be suspended in the polymer solution.

For example, the organic solution may be mixture of P22-27.5+Rifampin (10% w/w relative to polymer) and Minocycline (10% w/w relative to polymer) dissolved in a 9:1 mixture of THF: Methanol. 10% of fine powder of TXA (10% W/W relative to polymer) may be suspended in this solution and subjected to electrospray. The resulting nanofiber mat would therefore contain 10% each of Rifampin and Minocycline dissolved in the fibers and 10% TXA entrapped between fibers.