Immunologic Impact and Clinical Outcomes After Surgical Exposure to Bovine Thrombin

Ortel, Thomas L.; Mercer, Meg C.; Thames, Elizabeth; Moore, Karen D.; Lawson, Jeffrey H.

doi:10.1097/00000658-200101000-00014

Cited by 221 publications

(211 citation statements)

References 33 publications

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“…These antibodies may persist and may be associated with an increased risk for adverse clinical outcomes during subsequent surgical procedures. 25 Similar acquired thrombin and factor V inhibitors are recently reported in children exposed to topical bovine thrombin. 26 It is notable that one of the index cases underwent a repeat cardiac valvular replacement procedure 15 years after the initial event.…”

Section: Coagulopathy and Bleeding Following Exposure To Bovine Thromsupporting

confidence: 60%

Perioperative Evaluation of Bleeding Diathesis

Leung¹

2006

Hematology

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The differential diagnosis of a long APTT with a normal prothrombin time can be due to either a clotting factor deficiency or the presence of an inhibitor, which can be distinguished by using a plasma-mixing study. The various clotting factor deficiency states are reviewed. Clinical bleeding following cardiac bypass surgery due to acquired factor V and thrombin antibodies is also reviewed.In this brief review, a few selected topics on evaluation of bleeding diathesis in either a preoperative or postoperative setting will be discussed. Evaluation of a Prolonged APTT before SurgeryIt is fairly common that a hematologist is asked to see a patient, sometimes urgently, for evaluation of a long APTT discovered in a pre-operative setting. The anticipated surgery may vary from a relatively minor procedure to a major operation such as open-heart surgery or CNS surgery.The differential diagnosis of a long APTT with a normal prothrombin time is quite extensive, but can be divided into two groups, due to either a clotting factor deficiency or the presence of an inhibitor. The patient's history and physical examination are obviously important in considering the various possibilities. In eliciting a bleeding history, one should recognize its limitations. Mild bleeding symptoms are astonishingly common in the general population-epistaxis, easy bruising, and gum bleeding are reported in up to 25-45% of apparently healthy people, many of whom do not have any identifiable bleeding disorders.

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Section: Coagulopathy and Bleeding Following Exposure To Bovine Thromsupporting

confidence: 60%

Perioperative Evaluation of Bleeding Diathesis

Leung¹

2006

Hematology

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“…The use of autologous derived fibrinogen eliminates risk of viral transmission. Bovine thrombin, however, poses a risk as it elicits elevated production of IgG antibody which interacts with human coagulation proteins CME www.expert-reviews.com leading to hemorrhaging and thromboembolism [58]. Common adverse reactions associated with Vitagel are fever, pain, nausea and atelectasis [401].…”

Section: Vitagel (Orthovita) Surgical Hemostatmentioning

confidence: 99%

Tissue adhesives in ocular surgery

Park

Champakalakshmi

Panengad

et al. 2011

Expert Review of Ophthalmology

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“…18,19 Human thrombin has generally replaced bovine sources in these preparations, because in 126 cases since 1955, patients exposed to bovine thrombin have acquired thrombin antibodies. [20][21][22] In addition, Hino and coworkers 23 reported three cases of iatrogenic parvovirus B19 transmission associated with commercial sealants.…”

Section: Humphreys Et Al 1378mentioning

confidence: 99%

Renal Injury and the Application of Polysaccharide Hemospheres: A Laparoscopic Experimental Model

Humphreys

Lingeman

Terry

et al. 2008

Journal of Endourology

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Background and Purpose: Microporous polysaccharide hemospheres (MPH) are hemostatic beads engineered from purified plant starch. MPH accelerates the natural clotting cascade by concentrating clotting factors and proteins on their surface while absorbing aqueous and low molecular weight components from blood. The purpose of this study was to determine the efficacy of MPH in achieving hemostasis in the setting of laparoscopic renal injury. Materials and Methods:In four domestic pigs, 16 laparoscopic renal trocar injuries were created (8 each of 12 and 5 mm). A standard hand-assisted laparoscopic approach was used to each kidney so that two lesions per kidney were randomly created. MPH was applied to each treatment lesion with light pressure maintained for 60 seconds. Four of the 16 lesions, two each of 12 and 5 mm, were allowed to bleed as controls. Hemostasis was defined as no active bleeding or oozing. The animals were sacrificed at the conclusion of the procedure. Results: The mean time to hemostasis for the 12-mm MPH and control lesions was 196.2 Ϯ 53.3 and 372.0 Ϯ 225.6 seconds, while the average blood loss was 8.3 Ϯ 3.7 and 12.0 Ϯ 4.9 g, respectively. For the 5-mm MPH and control lesions, the average time to hemostasis was 100.2 Ϯ 24.8 and 247.0 Ϯ 134.4 seconds, while the average blood loss was 8.3 Ϯ 3.8 and 9.0 Ϯ 0.7 g, respectively. The median number of applications of the MPH for the 5-and 12-mm injuries was 1 and 2, respectively. Conclusions: MPH provided a rapid and effective means of hemostasis for laparoscopic renal parenchymal injuries in this model. Additional evaluation is warranted, however, before general application is advisable.

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Immunologic Impact and Clinical Outcomes After Surgical Exposure to Bovine Thrombin

Cited by 221 publications

References 33 publications

Perioperative Evaluation of Bleeding Diathesis

Perioperative Evaluation of Bleeding Diathesis

Tissue adhesives in ocular surgery

Renal Injury and the Application of Polysaccharide Hemospheres: A Laparoscopic Experimental Model

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