Coagulopathy as a result of factor V inhibitor after exposure to bovine topical thrombin.
We describe a case of severe coagulopathy after mesenteric revascularization. Laboratory investigation results revealed the presence of plasma inhibitors of factor V believed to result from exposure to bovine thrombin used for intraoperative hemostasis. Vascular and cardiothoracic surgeons commonly use topical thrombin for surgical hemostasis, and many patients undergo multiple exposure. More patients likely have factor V inhibitors develop than has previously been realized, and this may account for some otherwise unexplained postoperative coagulation disorders. This report may alert surgeons to coagulation disturbances that can result from exposure to bovine thrombin and provide guidelines for diagnosis and management.
Neschis
David G
DG
Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA. dneschis@smail.umaryland.edu
Heyman
Meyer R
MR
Cheanvechai
Vasana
V
Benjamin
Marshall E
ME
Flinn
William R
WR
D000287:Administration, Topical; D000368:Aged; D000818:Animals; D000906:Antibodies / Q000276:immunology; D001778:Blood Coagulation Disorders / Q000139:chemically induced*; D002417:Cattle; D005165:Factor V / Q000009:adverse effects* / Q000037:antagonists & inhibitors* / Q000276:immunology; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D013917:Thrombin / Q000009:adverse effects* / Q000276:immunology
D000906:Antibodies; D005165:Factor V; D013917:Thrombin