title: Severe coagulopathy following intraoperative use of topical thrombin.
abstract: This report describes a case of severe coagulopathy and bleeding related to the intraoperative use of topically applied thrombin. Commercial thrombin preparations contaminated with bovine factor V have been shown to stimulate the production of antibodies directed against factor V. These antibodies can cause coagulopathy. Our patient developed antibodies against factor V after intraoperative exposure to topical thrombin. The resulting antibody-mediated depletion of factor V caused a severe and refractory coagulopathy. Vascular surgeons should be aware that the use of topical bovine thrombin can cause severe coagulopathy.
authors.affiliation: Division of Vascular Surgery, University of Utah Health Sciences Center, Salt Lake City, UT 84103, USA. mark.sarfati@hsc.utah.edu
authors.forename: Mark R
authors.initials: MR
authors.lastname: Sarfati
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Dilorenzo
authors.forename: Larry W
authors.initials: LW
authors.lastname: Kraiss
authors.forename: Spencer W
authors.initials: SW
authors.lastname: Galt
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging; D005165:Factor V / Q000378:metabolism; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D010314:Partial Thromboplastin Time; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000000981:diagnostic imaging; D011517:Prothrombin Time; D012720:Severity of Illness Index; D013917:Thrombin / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D006490:Hemostatics; D005165:Factor V; D013917:Thrombin