Summary
Managing blood loss is part of the surgeon’s responsibility during surgical procedures,
and a variety of therapeutic strategies are available to help accomplish this. Topical
haemostatic agents are among the agents used to control surgical bleeding and locally
arrest blood flow. Bovine thrombin is a commonly used topical haemostatic agent; however,
its use has been associated with potential risks, including well-documented cases
of antibodymediated coagulopathy. This coagulopathy develops as a consequence of antibody
formation directed against bovine thrombin, other bovine coagulation proteins, and
their human orthologs. The fact that a coagulopathy can result in association with
the use of bovine plasma-derived thrombin preparations prompted the FDA to require
pharmaceutical companies to place a black-box warning in their prescribing information
for products containing bovine plasma-derived thrombin. Recently, human plasma-derived
thrombin and recombinant human thrombin have been approved by the FDA with the expectation
that they will be less immunogenic than the bovine-derived product. In clinical studies,
purified human plasma-derived thrombin and recombinant thrombin have demonstrated
equivalent efficacy and safety, with improved immunogenicity profiles compared with
bovinederived thrombin agents. Well-designed and adequately powered clinical trials
should be conducted to indicate whether human thrombin products would improve the
risk-benefit and costbenefit profiles for surgeries complicated by excessive bleeding.
Keywords
Bovine - coagulopathy - haemostasis - recombinant - thrombin