ABSTRACT
The achievement of hemostasis is paramount, and good operative practice is crucial
to all surgical procedures. Intraoperative hemostasis is usually achieved through
suture ligation for larger vessels and electrocautery of smaller vessels; certain
cases, however, are not amenable to these techniques, especially when there is diffuse
raw surface bleeding. When operative hemorrhage exists despite appropriate preventive
actions and good surgical technique, additional methods for controlling intra- and
perioperative hemorrhage should be considered, and may include the use of topical
thrombin. Recombinant human thrombin (rhThrombin) was approved by the Food and Drug
Administration in 2008, with the expectation of overcoming the disadvantages of previously
available topical thrombin preparations. The efficacy of rhThrombin has been demonstrated
in three randomized controlled trials and found to be effective for achieving hemostasis
within 10 minutes of administration for mild to moderate diffuse raw surface bleeding.
rhThrombin is equally as effective as bovine thrombin, with a significantly lower
risk of immunogenicity. Similar economic parameters, efficacy, and safety profiles
between rhThrombin and other available thrombin preparations may support its use over
other bovine- and plasma-derived human thrombin products and carry limited to no risk
of viral transmission or development of antithrombin antibodies.
KEYWORDS
Topical - recombinant thrombin - hemostasis - antithrombin antibodies - thrombin
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William C ChapmanM.D.
Professor and Chief, Division of General Surgery and Section of Abdominal Transplantation,
Washington University in St. Louis
660 South Euclid, Box 8109, St. Louis, MO 63110
eMail: chapmanw@wustl.edu
