Coagulopathy as a result of factor V inhibitor after exposure to bovine topical thrombin

Abstract

We describe a case of severe coagulopathy after mesenteric revascularization. Laboratory investigation results revealed the presence of plasma inhibitors of factor V believed to result from exposure to bovine thrombin used for intraoperative hemostasis. Vascular and cardiothoracic surgeons commonly use topical thrombin for surgical hemostasis, and many patients undergo multiple exposure. More patients likely have factor V inhibitors develop than has previously been realized, and this may account for some otherwise unexplained postoperative coagulation disorders. This report may alert surgeons to coagulation disturbances that can result from exposure to bovine thrombin and provide guidelines for diagnosis and management.

Octyl 2-Cyanoacrylate for Repair of Peripheral Nerve

“…8 -15 So far, these alternatives have been complicated by high dehiscence rates, significant coagulopathy, and also formation of uncontrolled clots, hypotensive responses, unacceptable foreign body reaction, allergic responses, and tissue toxicity. [15][16][17][18][19][20][21][22][23] In the case of the cyanoacrylate adhesives, the previous poor results have been due to the toxicity of using shortchained acrylates, causing extensive inflammation and fibrosis. 15,[23][24][25][26][27][28] Cyanoacrylate polymers yield formaldehyde as a by-product of hydrolytic degradation, which causes histotoxicity unless the level accumulated in the treated area is below the toxic threshold.…”

Bovine Thrombin Safety Reporting: An Example of Study Design and Publication Bias

“…All other case reports invariably describe patients whose prolonged prothrombin time (PT), thrombin time (TT), or activated partial thromboplastin time (aPTT) directed clinicians to order additional blood tests or conduct new assays. In this review, 40.9% of the authors attribute no adverse symptoms due to these abnormal clotting times [15][16][17][18][19][20][21][22]. The rest of the authors (59%) reported a total of 26 events.…”

“…Twenty-seven percent of authors called for additional studies, 31.8% advocated for more awareness and education, and 45% advised a change of practice [9,10,16,18,19,[21][22][23][24][26][27][28][29][30][31][32][33]. Of these, three authors advised additional assays for patients with prolonged clotting tests, two suggested limiting bovine exposure per patient, and one author each recommended replacing bovine thrombin or discontinuing its use [10,19,21,23,26,27,[29][30][31][32].…”

Blood Management: Conservation, Salvage, and Alternatives to Allogeneic Transfusion

“…Products may contain antifibrinolytics (aprotinin) to reduce fibrinolysis or factor XIII to increase strength of the clot (Fig. 35 In contrast, human thrombin, though virally inactivated, has a small risk for transfusion-transmitted disease. 34 A variety of commercially and individually produced fibrin sealants are available.…”