title: Safety and efficacy of a novel, dry powder fibrin sealant for hemostasis in hepatic resection.
abstract: OBJECTIVE
  Fibrocaps is a dry powder fibrin sealant containing human plasma-derived fibrinogen and thrombin. The safety, efficacy, and application methods for Fibrocaps were evaluated in an exploratory, first-in-human, noncomparative, clinical study.
  
  
  METHODS
  Patients with minor bleeding/oozing after elective partial hepatic resection had Fibrocaps applied to the bleeding site either directly from the vial or from a spray device, with manual pressure applied using a cellulose, collagen, or gelatin sponge, if needed. Safety was evaluated at screening and postoperative days 1, 2, and 5, and weeks 4 and 12. The formation of anti-thrombin antibodies was assessed at baseline, and after 4 and 12 weeks. Time to hemostasis (TTH) within 10 min was determined.
  
  
  RESULTS
  Twenty-nine patients were treated with Fibrocaps; 6 experienced serious adverse events that were not related to the course of treatment. Adverse events occurring in >10% of patients were nausea, constipation, hypotension, obstipation, hypokalemia, and postoperative pain. Most adverse events were mild or moderate in severity. No patient developed anti-thrombin antibodies. The percentage of patients who achieved hemostasis was 93%; the median TTH was 3.8 min (range 0.3-10.3). Manual pressure was applied with Fibrocaps in 19 patients and considered beneficial in most.
  
  
  CONCLUSIONS
  Fibrocaps was well tolerated in patients undergoing elective hepatic resection and resulted in rapid hemostasis. These safety and efficacy results support further clinical testing of this ready-to-use fibrin sealant as an adjunct to surgical hemostasis.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Ruitenbeek
authors.forename: N
authors.initials: N
authors.lastname: Ayez
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
authors.forename: J Hans W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Jan
authors.initials: J
authors.lastname: Bottema
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Rijken
authors.forename: Monique
authors.initials: M
authors.lastname: van Rij
authors.forename: Jaap
authors.initials: J
authors.lastname: Koopman
authors.forename: Linda A
authors.initials: LA
authors.lastname: Zuckerman
authors.forename: Paul
authors.initials: P
authors.lastname: Frohna
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
mesh_terms: D000368:Aged; D000906:Antibodies / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011208:Powders / Q000009:adverse effects / Q000627:therapeutic use*; D013917:Thrombin / Q000276:immunology; D013997:Time Factors
chemical_list: D000906:Antibodies; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D011208:Powders; D013917:Thrombin