Factor V Inhibitor after Injection of Human Thrombin (Tissucol) into a Bleeding Peptic Ulcer

Abstract

Endoscopic injection of fibrin glue into a bleeding peptic ulcer is an effective and safe treatment modality. The present report describes a patient who developed rectal bleeding from an arteriovenous malformation after endoscopic injection of fibrin glue containing human thrombin into a gastric ulcer. Additional laboratory investigations revealed the presence of an inhibitor against coagulation factor V, which resulted in severe coagulopathy, triggering the bleeding. Acquired factor V inhibitors have frequently been reported with the use of bovine thrombin, but to our knowledge, they have never been documented in patients exposed to human thrombin. Endoscopists should be aware of this rare, but potentially serious, complication.

The long term immunological response of swine after two exposures to a salmon thrombin and fibrinogen hemostatic bandage

“…In one study, cardiac surgery patients treated with fibrin glue containing bovine thrombin subsequently developed inhibitors of bovine thrombin and factor V activity [30]. Development of inhibitors to human factor V was also observed in several other cases even when human thrombin was used [31,32,36]. In several patients, this inhibitory response resulted in cases of clinical bleeding.…”

Bridging wounds: tissue adhesives’ essential mechanisms, synthesis and characterization, bioinspired adhesives and future perspectives

“…However, they needs preparation time before use, and fibrinogen and thrombin must be stored at low temperature separately. Fibrin adhesives may transmit infectious diseases because they are made from plasma, and they may elicit an immune response and cause an allergic reaction [ 36 , 37 ]. In addition, fibrin adhesives have poor adhesion strength when applied to tissue, and even worse on wet surfaces [ 38 ].…”