Severe Coagulopathy following Intraoperative Use of Topical Thrombin

Sarfati, Mark R.; DiLorenzo, Daniel J.; Kraiss, Larry W.; Galt, Spencer W.

doi:10.1007/s10016-004-0028-3

Cited by 56 publications

(52 citation statements)

References 7 publications

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“…The use of human and bovine tissue may also make the products unsuitable for use by some faiths. The final risk when using fibrin sealants is one of coagulopathy as the bovine thrombin is immunogenic and stimulates production of antibodies directed against factor V, resulting in severe and refractory coagulopathy [62]. …”

Section: Discussionmentioning

confidence: 99%

Methods of Haemostasis During Liver Resection - A UK National Survey

et al. 2013

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Background: Although haemorrhage is a major cause of morbidity and mortality in liver surgery, there is very little available guidance on its management. Methods: The aim of this study was to identify current practice in the UK in this regard. An online survey was created and hepatobiliary (HPB) specialists who were members of a specialist society and others who were known practitioners were invited by e-mail to complete the survey anonymously. Results: Fifty-one percent responded (n = 36/70), and most of these respondents worked at large HPB centres (>100 liver resections/year; n = 24, 66%). Not all questionnaires were fully completed by the individual surgeons. Thirty-eight percent of the surgeons routinely used Pringle's manoeuvre. Most surgeons used ligation of the inflow vessels (n = 16, 44%) and stapled the outflow vessels (n = 15, 42%). The Cavitron ultrasonic surgical aspirator (CUSA; 54%, 13/24) was preferred for parenchymal transection. The majority routinely used haemostatic adjuncts (n = 22, 62%), whilst 33% (n = 12) used them occasionally. Twenty-three (64%) felt manufactured haemostatic adjuncts played a major role in maintaining haemostasis and 19 preferred fibrin-based products. Conclusion: The Pringle manoeuvre is a popular technique amongst specialist UK liver surgeons and the CUSA is used by nearly half of the surgeons. Despite the absence of definitive evidence for their benefit, manufactured haemostatic adjuncts are still widely used, especially the fibrin-based adjuncts.

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Section: Discussionmentioning

confidence: 99%

Methods of Haemostasis During Liver Resection - A UK National Survey

et al. 2013

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“…However, the performance of current hemostatic materials is far from ideal. The efficacy of mechanical agents requires an intact coagulation cascade to ensure that fibrin is produced, and thus these agents will not be effective when hemorrhaging is caused by a significant coagulopathy [33] . In addition, the acidic nature of oxidized regenerated cellulose may also increase the chance of the inflammation of surrounding tissue and delay wound healing [34] .…”

Section: Discussionmentioning

confidence: 99%

A novel hemostatic sealant composed of gelatin, transglutaminase and thrombin effectively controls liver trauma-induced bleeding in dogs

Xie

Tian

et al. 2013

Acta Pharmacol Sin

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Aim: A novel hemostatic sealant based on the in situ gel formation of gelatin catalyzed by thrombin and crosslinked by transglutaminase was designed. The aim of this study was to investigate the efficacy of the hemostatic sealant in control of bleeding caused by liver trauma in dogs. Methods: Hepatic trauma that mimicked the grade III-IV rupture of liver was made in 20 dogs. The traumatic lesion was topically administered the hemostatic sealant (treatment group, n=10), or a thrombin solution (control group, n=10). The time to achieve hemostasis and the blood loss were measured. Contrast-enhanced ultrasound (CEUS) examination was performed in each animal on d 3, d 7, and d 10 d postoperatively to study the healing of the lesions. Results: The mean time to achieve hemostasis in the treatment group was significantly shorter than that in the control group (1.20±0.33 vs 6.70±0.64 min, P<0.05). The mean blood loss in the treatment group was significantly less than that in the control group (47.22±8.61 vs 79.29±11.97 mL, P<0.05). In CEUS examination, the traumatic lesions in the treatment group became significantly smaller on d 3, and disappeared on d 7, whereas the lesions in the control group still existed on d 10. Ascites were never found during 10 d follow-up in the treatment group but were observed on d 3 and d 7 in the control group. Conclusion: Compared with thrombin, the novel hemostatic sealant shows much better efficacy in hemostasis and may promote wound healing in dog liver trauma.

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“…[5][6][7] Granulomatous foreign body reactions and excessive fibrotic reactions may lead to catastrophic sequelae, particularly when the agents have been used within the abdominal cavity. Cases of appendicitis, 8 small bowel obstruction 9 and caseating peritoneal granulomas 10 have been described.…”

Section: Case Presentationmentioning

confidence: 99%

A surgeon, a rabbi and a lawyer walk in to an OR… Absorbable haemostatic agents and the dangers of product evolution – clinical, religious and legal implications

Gluch¹

2018

AMJ

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Please cite this paper as: Gluch L, Gluch N. A surgeon, a rabbi and a lawyer walk into an OR… Absorbable haemostatic agents and the dangers of product evolutionclinical, religious and legal implications. AMJ 2018;11 (1) ABSTRACTAdjunctive haemostatic agents have been used in surgery for over 70 years. What surgeons may not know is that products intended for similar applications may have very different biological properties and that occasionally product upgrades may introduce a change in the material's behaviour. Many of the agents employed to assist in haemostasis may have a biological (animal) origin. A recent case brought to light the need to recognise the possibility of biological interactions. As consideration into this surgical problem unfolded, religious and legal questions began to arise. Key WordsBreast reconstruction, haemostatics, adverse effects Implications for Practice: What is known about this subject?This case suggests the possibility that some "inert" haemostatic agents may result in allergic type reactions. It has not previously been reported. What new information is offered in this case study?The complex biological origin of haemostatic agents and the biological, religious and legal implications of using them.3. What are the implications for research, policy, or practice?

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Severe Coagulopathy following Intraoperative Use of Topical Thrombin

Cited by 56 publications

References 7 publications

Methods of Haemostasis During Liver Resection - A UK National Survey

Methods of Haemostasis During Liver Resection - A UK National Survey

A novel hemostatic sealant composed of gelatin, transglutaminase and thrombin effectively controls liver trauma-induced bleeding in dogs

A surgeon, a rabbi and a lawyer walk in to an OR… Absorbable haemostatic agents and the dangers of product evolution – clinical, religious and legal implications

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