title: Treatment of accidental perianal injection of topical thrombin with intravenous antithrombin.
abstract: While topical thrombin application can markedly improve surgical hemostasis, rapid absorption of thrombin can result in pulmonary embolism and death. We report a case of accidental interstitial infiltration of topical thrombin after hemorrhoidectomy that was treated with administration of human antithrombin and heparin anticoagulation. Except for a marked decrease in antithrombin activity from super normal to normal values, the patient exhibited no laboratory or clinical signs of pulmonary embolism, thrombin mediated consumptive loss of procoagulants, or regional thrombosis. The patient had an uncomplicated recovery without sign of thrombotic morbidity. While it is hoped that such a medical misadventure should not occur, our case may serve as a reference to guide anticoagulant therapy if such a clinical scenario arises.
authors: Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA. vgnielsen333@gmail.com.
authors: Vance G
authors: VG
authors: Nielsen
authors: Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA.
authors: Samata R
authors: SR
authors: Paidy
authors: Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA.
authors: Whitney
authors: W
authors: McLeod
authors: Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA.
authors: Alexandra
authors: A
authors: Fox
authors: Department of Surgery, The University of Arizona College of Medicine, Tucson, USA.
authors: Valentine N
authors: VN
authors: Nfonsam
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019300:Medical Errors / Q000009:adverse effects*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000517:prevention & control; D013917:Thrombin / Q000009:adverse effects*; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006493:Heparin; D013917:Thrombin
keywords: Antithrombin; Heparin; Medical error; Topical thrombin