Fibrin glue achieves hemostasis in patients with coagulation disorders.
Fibrin glue (FG), made with highly concentrated human fibrinogen and clotting factors, was used to achieve parenchymal organ hemostasis in patients with disordered coagulation secondary to massive transfusion, chronic disease, and disseminated intravascular coagulation; it was effective in controlling liver hemorrhage in seven patients and in the performance of a splenorrhaphy in one other patient. The coagulation profile was grossly abnormal in all patients, and the mean +/- SD intraoperative blood loss was 5.1 +/- 4.2 L; patients received 14 +/- 10 U of blood perioperatively. The amount of FG required to achieve hemostasis varied directly with the extent of injury and intraoperative blood loss (r = .84), and all patients with a blood loss greater than 4 L required at least 25 mL of FG to stop bleeding. Two patients died postoperatively secondary to cardiac arrest and adult respiratory distress syndrome. Because FG does not depend on adequate platelet or clotting factor levels to be effective, it is especially useful in patients with parenchymal organ hemorrhage and disordered coagulation.
Kram
H B
HB
Department of Surgery, Martin Luther King, Jr-Charles R. Drew Medical Center, Los Angeles, CA 90059.
Nathan
R C
RC
Stafford
F J
FJ
Fleming
A W
AW
Shoemaker
W C
WC
D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000209:etiology; D002908:Chronic Disease; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D004338:Drug Combinations / Q000627:therapeutic use; D005176:Factor XIII / Q000627:therapeutic use*; D005260:Female; D005337:Fibrin / Q000627:therapeutic use*; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen / Q000627:therapeutic use*; D006488:Hemostasis, Surgical; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008297:Male; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013917:Thrombin / Q000627:therapeutic use*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D065227:Transfusion Reaction
D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D005337:Fibrin; D005340:Fibrinogen; D005176:Factor XIII; D007611:Aprotinin; D013917:Thrombin