Fibrin tissue adhesive" (FTA) is the name given to products, originally made from plasma proteins, that mimic the last step of the physiological coagulation cascade to form fibrin clot. The idea of enhancing hemostasis at the site of injury by local application of FTA versions dates back to the beginning of the century (l). In Europe, commercial FTAs products have been used extensively for almost 20 years for a variety of indications including hemostasis, sealing, adhesives ("gluing"), and slow release delivery system for materials such as antibiotics or growth factors. However, prospective series documating safety and efficacy for most of the indications for which FTA are used have been lacking. A few recent experimental and clinical trials suggest that in spite of the extensive clinical experience over the years , there may be no clinically important benefit of using FIA in some indications (2-5) while in others even harmful effect is suggested (6,7). The composition of IIIA, concentration of ingredients, addition in some preparates of bovine aprotinin and F. XItr are also based on in vitro data and animal experiments but not on clinical research and no standards exist for the formulation or evaluation of these products. Most users in Europe are considering FTA to be a generic name and are not aware of their large variations. Studies performed with different forms of FTA may have different outcomes (8,9) and may not be applicable to all formulations of FIA. In the US the FDA has still not aproved commercial FTA due to the lack of data on safety and efficacy. Another obstacle for approval is the "combination product regulations" that require proof for the role of each of the added components (as bovine aprotinin) to the claimed effect. (Natural proteins that are co-purify with fibrinogen do not require such proof). Insteadan extensive use of non commercial FTA was developed in the US based on blood bank products. Heterologous cryoprecipitate is used in9OVo of cases, (10) but also autologous cryoprecipitate, fresh frozen plasma or platelet rich plasma (11-13) which are combined with commercial bovine thrombin (10) to produce FTA. These combinations have much lower margin of safety as compared to commercial FTAs, which avoid the use bovine thrombin and undergo viral inactivation.