Adverse effects of fibrin sealants in thoracic surgery: the safety of a new fibrin sealant: multicentre, randomized, controlled, clinical trial.
OBJECTIVE
The safety of fibrin sealants (FS) has been questioned in the light of recent reports of adverse effects. We evaluated the safety of a new FS in a randomized controlled trial (RCT).


METHODS
Multicentre, open-label Phase II/III RCT to evaluate the safety of the new FS. The trial was approved by the Ethic Committee of each three participating Centre. FS includes two components (component 1: fibrinogen; component 2: thrombin), each of them subjected to two viral inactivation procedures. Out of 200 screened patients, 185 eligible patients (49 females, 136 males), aged between 18 and 75 years, undergoing major thoracic surgery were randomized to receive FS (#91 patients) as an adjuvant for air leak control or no treatment (#94 patients, control group). Safety variables were: percentage of subjects with adverse events associated with the therapy; formation of antibodies against bovine aprotinin; vital signs (blood pressure, body temperature, heart and respiratory rate); laboratory parameters.


RESULTS
Overall operative mortality was 3.2% (6/185), 1.1% in the FS group and 5.3% in the control group, respectively. Twenty patients (22%) had adverse events in the FS group and 22 (23.4%) in the control group. Atrial fibrillation (five patients in the FS group and four in the control group) and hyperpyrexia (five and seven patients, respectively, in the two groups) were the most common adverse events. No patient reported thromboembolic events (pulmonary embolism or deep vein thrombosis) during the in hospital stay or within 1 month from discharge. None of the adverse events was considered as treatment related. The formation of bovine aprotinin antibodies was reported in a total of 34 patients (37.4%) in the FS group and was not related to any adverse effect.


CONCLUSIONS
The present RCT did not show any increased risk of adverse events, and of surgical complications, related to the use of the new FS.
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy. gcardillo@scamilloforlanini.rm.it
Giuseppe
G
Cardillo
Francesco
F
Carleo
Luigi
L
Carbone
Alessia Raffaella
AR
De Massimi
Achille
A
Lococo
Paolo F
PF
Santini
Alberto
A
Janni
Alessandro
A
Gonfiotti
D000293:Adolescent; D000328:Adult; D000368:Aged; D000917:Antibody Formation; D007611:Aprotinin / Q000276:immunology; D001281:Atrial Fibrillation / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects* / Q000627:therapeutic use; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods; D006490:Hemostatics / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology / Q000517:prevention & control; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D014014:Tissue Adhesives / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014014:Tissue Adhesives; D007611:Aprotinin