title: Safety and efficacy of thrombin-JMI: a multidisciplinary expert group consensus.
abstract: BACKGROUND
  The use of bovine thrombin has been an effective approach to aiding hemostasis during surgery for over 60 years. Its use has a reported association with the development of antibodies to coagulation factors with limited evidence to the clinical significance.
  
  
  METHODS
  The Collaborative Delphi survey methodology was used to develop a consensus on specified topic areas from a panel of 12 surgeons/scientists who have had experience with topical thrombins; it consisted of 2 rounds of a Web-based survey and a final live discussion.
  
  
  RESULTS
  Some key issues that reached consensus included: bovine, human plasma-derived and recombinant human thrombin are equally effective hemostatic agents with similar adverse event rates, and immunogenicity to a topical protein rarely translate into adverse events.
  
  
  CONCLUSIONS
  Although a risk of immunogenicity is associated with all topical thrombins, no conclusive clinical evidence is available that these antibodies have any significant effect on short- and long-term clinical consequences.
authors.affiliation: McMaster University, Hamilton, ON, Canada. bhandam@mcmaster.ca
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Ofosu
authors.forename: Nigel
authors.initials: N
authors.lastname: Mackman
authors.forename: Craig
authors.initials: C
authors.lastname: Jackson
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
authors.forename: John E
authors.initials: JE
authors.lastname: Humphries
authors.forename: Sateesh C
authors.initials: SC
authors.lastname: Babu
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.forename: David
authors.initials: D
authors.lastname: Hoffman Van Thiel
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Walenga
authors.forename: Rakesh
authors.initials: R
authors.lastname: Wahi
authors.forename: Kevin Hong To
authors.initials: KH
authors.lastname: Teoh
authors.forename: Jawed
authors.initials: J
authors.lastname: Fareed
mesh_terms: D000287:Administration, Topical; D000818:Animals; D001323:Autoantibodies / Q000276:immunology*; D002417:Cattle; D003625:Data Collection; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D008297:Male; D013514:Surgical Procedures, Operative; D013917:Thrombin / Q000009:adverse effects* / Q000276:immunology* / Q000627:therapeutic use*
chemical_list: D001323:Autoantibodies; D013917:Thrombin