title: A randomized trial of aprotinin-free fibrin sealant versus absorbable hemostat.
abstract: BACKGROUND
  This study evaluated the safety and hemostatic effectiveness of a tranexamic acid- and aprotinin-free fibrin sealant versus an absorbable hemostat in soft tissue during elective retroperitoneal or intra-abdominal surgery.
  
  
  METHODS
  This randomized, active-controlled, multicenter study enrolled patients who were undergoing elective retroperitoneal or intra-abdominal surgery and required adjunctive hemostatic measures at the target bleeding site (TBS). Patients were randomized (time = 0 minutes) to receive fibrin sealant or absorbable hemostat. The primary endpoint was the absence of bleeding at the TBS at 10 minutes. Secondary endpoints included the absence of bleeding at 4 and 7 minutes and the incidence of treatment failure (bleeding at 10 minutes or brisk bleeding requiring additional hemostatic measures), and the incidence of complications potentially related to bleeding. Adverse events were assessed.
  
  
  RESULTS
  Patients (N = 124) were randomized to receive fibrin sealant (n = 62) or absorbable hemostat (n = 62). A higher percentage of patients who received fibrin sealant versus absorbable hemostat achieved hemostasis within 10 minutes (95.2% vs 82.3%; 95% CI, 1.02-1.35) and also at 4 (74.2% vs 54.8%; 95% CI, 1.04-1.80) and 7 (90.3% vs 77.4%; 95% CI, 1.00-1.39) minutes. A lower incidence of treatment failure was observed for patients receiving fibrin sealant. Similar incidences of adverse events and complications potentially related to bleeding were observed.
  
  
  CONCLUSIONS
  This tranexamic acid- and aprotinin-free fibrin sealant is safe and effective for achieving hemostasis in soft tissue during elective retroperitoneal or intra-abdominal surgery.
authors.affiliation: Department of Surgery, The Methodist Hospital and Weill Medical College of Cornell University, Houston, TX 77030, USA. CPFischer@tmhs.org
authors.forename: Craig P
authors.initials: CP
authors.lastname: Fischer
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Jessica
authors.initials: J
authors.lastname: Shen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Batiller
authors.forename: James C
authors.initials: JC
authors.lastname: Hart
authors.forename: Bababhai
authors.initials: B
authors.lastname: Patel
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007611:Aprotinin / Q000627:therapeutic use*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D007611:Aprotinin