Fatal thromboembolism to the left pulmonary artery by locally applied hemostatic matrix after surgical removal of spinal schwannoma: a case report

Use of thrombin‐based haemostatic matrix in head and neck reconstructions: a potential risk factor for pulmonary embolism

“…There have been previous studies that identified the association between the use of FloSeal and incidence of embolisms . In particular, there has been a report of a fatal PE by locally applied haemostatic matrix after surgical removal of spinal schwannoma .…”

“…This supports the mechanism described by Steinestel et al . that topical application of FloSeal can result in lodgement of FloSeal particles in pulmonary vessels resulting in PE . In this proposed mechanism, the causation of PE is not related to blood coagulation alone and would render traditional anticoagulation ineffective in the prevention of VTE.…”

“…The collagen or gelatin granules from these agents restrict blood flow and provide a physical matrix to support clot formation, while delivering thrombin to exposed microvessels to activate clotting. Recent studies suggest that this may potentially activate systemic coagulation resulting in thromboembolic events . Safaee et al analysed 467 patients who underwent craniotomies for meningioma and found a significant association between the volume of FloSeal (Baxter Healthcare, Deerfield, IL, USA) used intraoperatively and the incidence of postoperative PE.…”

Gelatine matrix with human thrombin decreases blood loss in adolescents undergoing posterior spinal fusion for idiopathic scoliosis

“…11,12 In addition to increased cost, the use of gelatine matrix has been associated with rare but severe peri-operative complications. [17][18][19][20] Anaphylaxis has occurred during posterior 17 and anterior surgery for spinal deformity. 18 There have also been two reports of epidural spinal cord compression with neurological deficits.…”

Non-Fatal Thrombin Based Hemostatic Matrix Pulmonary Embolism in Laparoscopic Surgery. A Case Report

“…Although in regular hemostasis the body is able to counteract clotting via release of antithrombotic molecules, such as anti-thrombin, Proteins C and S, and tissue factor pathway inhibitor, intravascular embolization of large amounts of thrombin can produce devastating effects [3]. Several papers reported single cases or series of fatal pulmonary embolism in different surgical context, such as head and neck plastic surgery, neurosurgery or orthopedics [4][5][6][7]. This is to the best of our knowledge the first report of this adverse reaction in laparoscopic surgery.…”