title: A comparison of fibrin sealants in relation to their in vitro and in vivo properties.
abstract: BACKGROUND
  Fibrin sealants (FS) have been used for many years to facilitate hemostasis and to provide suture support and sealing/adhesion of tissues after surgery. While their composition is similar, different formulations, application devices, and varying concentrations of key components mean that the properties of clots formed by individual FS can be diverse.
  
  
  METHODS
  We performed several studies, including animal models, to compare the properties of 12 different commercially available FS/application device combinations using partial liver and kidney resection models to assess hemostatic efficacy and a novel pig skin model to measure adhesive clot strength. The quality of mixing was determined using colored spray images.
  
  
  RESULTS
  Although the FS tested shared the principle of combining fibrinogen and thrombin, major differences were found between the individual preparations with regard to hemostatic efficacy. Two pre-requisites for successful early hemostasis were identified--adequate clottable protein content and the ability of the application device to effectively mix the fibrinogen and thrombin components of the FS. Factor XIII activity was a key determinant in prevention of re-bleeding and premature clot lysis. Furthermore, FS lacking measurable factor XIII activity formed the weakest, softest clots.
  
  
  CONCLUSIONS
  Clearly, all FS are not the same, and their different characteristics may potentially translate into different clinical outcomes. In our studies, while all FS tested performed well on individual parameters, Beriplast P (Aventis Behring) was the foremost FS in consistently providing early hemostasis, minimizing the risk of re-bleeding, and providing strong adhesive clots capable of resisting mechanical forces.
authors.affiliation: Pharmacology and Toxicology, Aventis Behring, P.O. Box 1230, D-35002 Marburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Dickneite
authors.forename: Hubert
authors.initials: H
authors.lastname: Metzner
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfeifer
authors.forename: Monika
authors.initials: M
authors.lastname: Kroez
authors.forename: Günther
authors.initials: G
authors.lastname: Witzke
mesh_terms: D000268:Adhesiveness; D000327:Adsorption; D000818:Animals; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D006487:Hemostasis / Q000187:drug effects*; D006490:Hemostatics / Q000494:pharmacology*; D007668:Kidney / Q000473:pathology / Q000601:surgery; D008099:Liver / Q000473:pathology / Q000601:surgery; D008297:Male; D008422:Materials Testing / Q000379:methods*; D011817:Rabbits; D012867:Skin / Q000378:metabolism*; D013552:Swine; D013718:Tensile Strength; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics