Fibrin glue (also called fibrin sealant) is a surgical formulation used to create a fibrin clot for hemostasis, cartilage repair surgeries or wound healing. It contains separately packaged human fibrinogen and human thrombin.
Medical uses
This
glue is used as a
Adjuvant therapy in surgery (such as liver surgery) for the improvement of
hemostasis where standard surgical techniques are insufficient or impractical.
It is also used for repairing dura mater tears and bronchial and for achieving hemostasis after spleen and liver trauma,
It can also be used to treat pilonidal sinus disease but it is of unclear benefit as of 2017, due to insufficient research.
Contraindications
The glue must not get into blood vessels, as this could lead to clotting in the form of
thromboembolism or disseminated intravascular coagulation, or to
anaphylaxis (a severe allergic reaction).
Side effects
Possible adverse effects include bleeding disorder and allergic reactions such as flushing, stinging, generalised
urticaria,
angioedema,
bronchospasm, and anaphylaxis. Other adverse effects in studies occurred in roughly equal proportions in treatment and
placebo groups.
Interactions
As fibrin glue contains proteins, it may be denatured by
ethanol,
iodine and
heavy metals. These substances are frequently found in
antiseptic solutions.
Pharmacology
Mechanism of action
Thrombin is an
enzyme that splits
fibrinogen into
fibrin monomers in 10 to 60 seconds, which aggregate to form a three-dimensional gel-like structure. Thrombin also activates
factor XIII from the human body to factor XIIIa, which then cross-links the fibrin monomers to form a stable clot. Both these processes need
calcium to work. As the wound heals, the clot is slowly degraded by the enzyme
plasmin.
Pharmacokinetics
In rabbit studies, only 1 to 2% of the applied thrombin dose reached the bloodstream. It reached highest blood plasma concentrations after 6 to 8 hours.
Chemistry
Composition
Fibrin glue comes in two vials, respectively containing:
-
fibrinogen: lyophilised pooled human concentrate
-
thrombin: This used to be of bovine origin; modern formulations contain human thrombin.
[
]
The two components are mixed immediately before application.[ ]
Formulations from different manufacturers may also contain aprotinin, fibronectin, plasminogen, and factor XIII.[ KEGG drug: Factor XIII with fibrinogen. Accessed 9 July 2020.]
Legal status
A formulation with human thrombin was approved for medical use in the United States in March 2003, and in the European Union in October 2008.
