Clotto is available in 2 formats as follows:

Spray: Each container contains: Oxidised cellulose 6.35% w/w
Method of use: Shake the can and after removing the cap, spray liberally from a distance of about 15cm, applying powder to uniformly cover the wound area. Repeat the application if needed, allowing a few seconds for the liquid to evaporate. When Clotto is sprayed, the liquid component of the content rapidly evaporates, leaving a thick layer of dry, white to creamy coloured powder on the treated surface.

Powder: Each container contains: Oxidised cellulose 1 gm
The powder is applied to the bleeding area (after removing the cap), by compressing repeatedly on the walls of the container. The layer thickness will be 1-2mm depending on the intensity of bleeding of the surgical wound.

On saturation with blood, the powder layer quickly becomes red to dark brown. Haemostatis is obtained shortly after application.

Depending on the extent of bleeding, the wound area is treated with an amount of the powder adequate to produce thrombi and to obtain perfect haemostatis. In case of a profusely bleeding wound, it is advisable to put the powder onto gauze, and then to place the gauze on to the wound; temporary pressure may be applied when needed until haemostatis is obtained

Clotto which contains oxidized cellulose works by a surface effect through its ability to bind with haemoglobin leading to aggregation of erythrocytes or acceleration of fibrinogen formation.

The preparation is used for stopping capillary bleeding associated with minor cuts grazes and surface wounds.

Parenchymatous bleeding in surgery where other methods of local haemostasis or parental application of haemostatic agents are inadequate or suturing or ligation is impracticable

What is Clotto?
Clotto is a haemostypic dusting spray, forming an artificial clot with minimal tissue reactivity. It adheres to the bleeding site by quick absorption of blood with fast coagulation at the interface, leaving the outer layer of material dry so that it can serve as blockage to the blood outflow.

Physical and Chemical Properties:
• Appearance: White to creamy yellow amorphous powder.
• Odour: Odourless to slight scorchy odour.
• Solubility: Partially soluble in water to form a colloidal dispersion, soluble in alkalis. Insoluble in common organic solvents.
• Bulk Density: 100 to 1000 kg/m3 depending on granularity, porosity, and specific surface area.

How does Clotto work?
The mechanism of haemostatic action of Clotto (oxidized cellulose) is by a surface effect through its ability to bind with haemoglobin leading to aggregation of erythrocytes or acceleration of fibrinogen formation. It also has a weak bactericidal action.

Clotto adheres by the image of an ideal local haemostypic that involves following characteristics:

• Ample haemostatic action
• Minimal tissue reactivity • Low cost
• Biodegradability in vivo
• Non antigenic
• Easy to apply to the bleeding wound & to tailor or fold over the bleeding area
• Adhering to the bleeding site by quick absorption of the blood with fast coagulation at the interface
• Leaving the outer layer of material dry so that it can serve as an occlusive tamponade and/or a concomitant indicator of adequate haemostasis

Toxicity
Biological evaluation performed on the active substance confirmed no skin irritation or sensitization potential. A slight toxicity potential for the material extract has been revealed under the test conditions in cytotoxicity test; this potential does not manifest itself in the overall local skin reaction in vivo, and can in contrast act as an initiator of healing processes. Very low systemic toxicity (LD50 greater than 5 g per kg body weight for small animals) and no adverse effects at multiple overdosing are observed, as compared with typical dosage of less than 1 g per treatment

Toxicological  Information
I.p. rat LD50: > 4,300 mg/kg; i.p. rabbit LD50: > 4,000 mg/kg

Sterility
Sterility of product is ensured by exposing every batch in its final packaging to a validated gamma sterilization process by a dose of 25kGy

Storage
g.i. Store below 25°C and protect from direct sunlight and excessive heat

Safety Precautions:
• Avoid eye contact. If spray enters eyes, wash with plenty of water. Get medical advice if irritation persists.
• Do not pierce or burn the can, even when empty
• The contents are extremely flammable. Therefore do not spray on a naked flame or any incandescent material. Keep away from any sources of ignition and do    not smoke when using CLotto
• If pregnant or lactating, use Clotto only if advised by doctor or physician
• Keep away from children

First Aid Measures:
• Inhalation: Move the patient to an area which is well-ventilated for fresh air. Get medical attention for any breathing difficulty
• Ingestion: if a large amount was swallowed, give the patient water to drink. Get medical attention if adverse symptoms develop
• Using the product other than to stop capillary bleeding (e.g. for treatment of pressure bleeding from large vessels) will immediately show continued bleeding    and the user is advised to seek medical advice in such a case

Conclusion
• Clotto offers good haemostatic effects, high bio-solubility and bio-degradability, antioxidant and wound-healing properties.
• Clotto provides very good tolerability and safety.
• Clotto shows good activity against micro-organisms.
• Confirmed bactericidal effect against a wide spectrum of aerobic and anaerobic pathogens increase the therapeutic potential for use in clinical practice.
• Non antigenic

References of Clinical Studies
Read more about the clinical studies that are pertinent to Clotto

• Effect of oxidized cellulose on fibrin formation and blood platelets. Cas Lek Cesk. 2002 Sep 22; 141 Suppl: 50-3.
• The influence of intrinsic coagulation pathway on blood platelets activation by oxidized cellulose. J Biomed Mater Res A. 2007 Aug; 82(2):274-80
• Effects of oxidized cellulose and microfibrillar collagen on infection. Surgery. 1982 Mar; 91(3):301-4.
• Clinical benefits and risk analysis of topical hemostats:  A review. J Artif Organs. 2005; 8(3):137-42.
• A comparison between two absorbable hemostatic agents:  Gelatin sponge and oxidized regenerated cellulose. Int  J Oral Surg. 1984 Oct; 13(5):406-10
• Oxidized cellulose dressings for persistent bleeding from a superficial malignant tumour. Am J Hosp Palliat Care. 2002 Nov-Dec; 19(6):417-8.
• Esthetic surgery  -  repair of decubital defect  in a paraplegic
• Hemostatic effects of Oxidized cellulose. Ceska Slove Farm. 2008  Jan; 57(1):11-6
• In vitro antimicrobial activity of oxidized regenerated cellulose against antibiotic resistant micro-organism. Surg Infect (Larchmt). 2003; 4(3):255-62