title: Bovine thrombin induces an acquired coagulopathy in sensitized patients undergoing revision spinal surgery: a report of two cases.
abstract: METHODS
  A report of two cases is presented.
  
  
  OBJECTIVE
  To raise awareness of bovine thrombin-induced factor V deficiency.
  
  
  BACKGROUND
  Bovine thrombin is a frequently used hemostatic agent in spinal surgery. Current preparations contain clotting factors in addition to thrombin, particularly factor V, which are immunogenic. Re-exposure of sensitized patients to bovine thrombin products during subsequent surgery may lead to the formation of antibodies that cross-react with human clotting factors, most commonly against factor V. Hemorrhagic complications have been reported in nonspinal patients due to a bovine thrombin-induced factor V deficiency.
  
  
  METHODS
  Two spinal cases are reported, and the literature is reviewed.
  
  
  RESULTS
  In the cases outlined, both patients underwent revision spinal surgery, with re-exposure to bovine thrombin. Both patients developed abnormal coagulation profiles, with an acquired factor V deficiency. No hemorrhagic complications occurred; however, second-stage surgery was delayed in one patient and not undertaken in the other. In both patients, the coagulopathy resolved spontaneously.
  
  
  CONCLUSIONS
  Bovine thrombin-induced coagulopathy is well recognized in cardiac surgery but has not been reported in spinal surgical patients. Data available from cardiac surgical patients suggests that those who are sensitized to two or more bovine clotting factors are at greatest risk of hemorrhagic complications. The cases we present demonstrate that this phenomenon occurs in spinal surgical patients and serve to raise awareness of the potential danger of bovine thrombin in sensitized patients.
authors.affiliation: Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA. poyntona@hss.edu
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Poynton
authors.forename: Mark C
authors.initials: MC
authors.lastname: Nelson
authors.forename: Sean E
authors.initials: SE
authors.lastname: McCance
authors.forename: Randy L
authors.initials: RL
authors.lastname: Levine
authors.forename: Patrick F
authors.initials: PF
authors.lastname: O'Leary
mesh_terms: D005165:Factor V / Q000037:antagonists & inhibitors* / Q000276:immunology; D005166:Factor V Deficiency / Q000139:chemically induced* / Q000276:immunology; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000276:immunology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011517:Prothrombin Time; D012086:Reoperation; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000276:immunology* / Q000601:surgery; D013917:Thrombin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D005165:Factor V; D013917:Thrombin