A strategy for reperfusion involving the transfer of patients to an invasive-treatment center for primary angioplasty is superior to on-site fibrinolysis, provided that the transfer takes two hours or less.

TachoSil was significantly superior to standard haemostatic fleece material in obtaining effective and fast intra-operative haemostasis in cardiovascular surgical procedures. TachoSil was safe and well tolerated.

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Aim: To evaluate the haemostatic properties of Vivostat^® patient-derived fibrin sealant in a broad range of surgical procedures. Method: In a prospective, randomised, multicentre, clinical study, typical surgical wounds of 69 patients (cardiothoracic, general, obstetric and gynaecologic, and vascular), requiring intervention to control bleeding, were treated with either Vivostat-derived sealant (n = 35) or Surgicel^® (n = 34) as required and the time taken to arrest bleeding was assessed. Results: Compared with Surgicel, the mean time to haemostasis of Vivostat-derived sealant was significantly shorter (1.6 vs. 3.3 min, p < 0.0001) and more patients were successfully treated (i.e. no additional haemostatic measures required; 94 vs. 65%, p = 0.003). Conclusion: Vivostat-derived sealant is a more reliable and rapidly effective surgical haemostat than Surgicel.

Fibrin glue was prepared from citrated plasma of human donors by means of ethanol. The outcome was a fibrinogen concentrate with a mean concentration of 43 mg/ml. The fibrinogen was converted to fibrin by the addition of 0.3 part of thrombin solution, 150 NIH U/ml, containing 100 mM calcium chloride. In a rat model full-thickness skin grafts were sealed with the glue, and the adhesive strength was measured at different fibrin concentrations, and after a variable reaction time, and compared to commercial fibrin glue (Tisseel®). The strength of ethanol-prepared glue was directly proportional to the fibrin concentration, and increased rapidly within the first minutes of the reaction time. The strength of the commercial glue could be obtained with autologous fibrin glue at the same fibrin concentration.

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Objective. More than 2300 clinical papers have been published on the surgical applications of fibrin sealant (FS), with the largest number in the speciality of cardiothoracic surgery. The purpose of this review of the literature was to find and evaluate controlled studies published in the field of cardiothoracic surgery, to clarify the indications and emphasize the benefits of FS available to the practising surgeon. Methods.A database of the surgical publications of FS was created. Up to the end of 1995, at least 24 controlled clinical studies had been published; these may be divided into 20 studies with a positive outcome and 4 studies where the results were not different from the controls. In none of the studies was the clinical result worse after the use of FS.Results. In most of the cardiac studies, FS was successfully used at bleeding sites in reoperations and in congenital heart surgery. Postoperative bleeding may also be reduced by the anterior mediastinal spray application of FS or by preparing woven Dacron prostheses with the sealant. In addition, FS has been found to improve results after type A aortic dissections and, by adding an antibiotic to the sealant, the postoperative infection rate for active endocarditis of the aortic root can be reduced. In pulmonary surgery FS can be used to reduce pulmonary air leakage, however the results of some studies diverge due to different clinical test conditions and the inclusion of only a small number of patients in the "negative" studies. In none of the controlled studies of esophageal surgery could FS prevent leakage from esophageal anastomoses_ Conclusions. Fibrin sealant is safewhen it is applied properly, but there is a learning curve for surgeons who start using it. An autologous sealant or a sealant containing human instead of bovine thrombin is preferred, since repeated use of bovine thrombin may induce coagulopathies. The number of controlled clinical studies of FS is currently increasing, with the majority of the papers revealing a beneficial effect of FS when it is used as a hemostatic or sealing agent in cardiothoracic surgery. [Eur J Cardio-thorac Surg (1996) 10:727-733]

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