Bovine thrombin: history, use, and risk in the surgical patient.
Thrombin is a common hemostatic drug used in surgical practice for over 100 years because of its simplicity and efficacy. Thrombin converts fibrinogen to fibrin, activates platelets, and induces vascular contraction. It is available in multiple forms, including human thrombin, bovine thrombin, and, most recently, human recombinant thrombin. Over 100 case reports of adverse reactions to bovine thrombin include hemorrhage, thrombosis, and substantial immune reaction when used on cardiovascular surgery patients. Approximately 30% of patients exposed to bovine thrombin develop cross-reacting antibodies. Thirty percent of patients with anticlotting factor antibodies develop abnormal coagulation that can be detected by prothrombin time, partial thromboplastin time, or thrombin time, which makes anticoagulation monitoring difficult. Patients with multiple elevated antibodies prior to surgery are also more likely to sustain adverse events. Animal studies confirm these immunological responses seen in humans. With the available clinical and laboratory data, a less immunogenic yet biologically effective thrombin should be available for use in our surgical patients.
Diesen
Diana L
DL
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Lawson
Jeffrey H
JH
D000818:Animals; D000906:Antibodies / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D002417:Cattle; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000266:history / Q000379:methods*; D006490:Hemostatics / Q000009:adverse effects / Q000266:history / Q000276:immunology / Q000627:therapeutic use*; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D023421:Models, Animal; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment; D013917:Thrombin / Q000009:adverse effects / Q000266:history / Q000276:immunology / Q000627:therapeutic use*; D016896:Treatment Outcome
D000906:Antibodies; D006490:Hemostatics; D011994:Recombinant Proteins; D013917:Thrombin