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Fibrin glue
General information
Fibrin glue is a topical tissue adhesive, a two-component system. One component contains highly concentrated fibrinogen, factor VIII, fibronectin, and traces of other plasma proteins. The other component contains thrombin, calcium chloride, and antifibrinolytic agents such as aprotinin. Mixing the two components promotes clotting. Fibrinogen is activated by thrombin in the presence of calcium, and the resultant clot aids hemostasis and tissue sealing and is completely absorbed during wound healing without foreign body reaction or extensive fibrosis. Fibrin glue thus imitates the final stages of coagulation [ ] and is used for tissue sealing, hemostasis, and wound healing.
Because of adverse reactions, the original topical fibrin glue, which contained thrombin of bovine origin, has been withdrawn and replaced by a product (Quixil) whose components are all human in origin and not bovine or recombinant. Tranexamic acid is added in order to increase stabilization of the clot. The fibrinogen component is made from pooled plasma and is not highly purified; it therefore contains factor XIII, which also stabilizes the clot. Methods involving precipitation of fibrinogen by cryoprecipitation, polyethylene glycol, or ammonium sulfate have been described and evaluated.
All the components of fibrin glue are subjected to virucidal treatment (solvent/detergent treatment for fibrinogen and nanofiltration for thrombin).
Uses
The primary purpose of using fibrin glue is to reduce blood loss and hence the need for transfusion. It is sprayed on to a surgical field in aerosolized form with a double-barrelled syringe, using either compressed air or nitrogen. Its hemostatic and adhesive properties can be used in any surgical specialty, for example to control bleeding after organ injury [ ]. Its usefulness is particularly well documented in the fields of cardiovascular surgery [ , ], ENT surgery [ ], neurosurgery [ ], and thoracic surgery [ ].
Fibrin glue has been widely used to treat anal fistulae. In a systematic review of 19 studies the reported success rates ranged from 0% to 100%, which may have been due to differences in patient selection (including fistula aetiology and type), treatment protocols, and follow-up duration [ ].
The hemostatic efficacy of fibrin glue in a nasal spray has been studied in 24 patients with hereditary hemorrhagic telangiectasia and epistaxis [ ]. Fibrin glue produced immediate hemostasis and good healing of bleeding sites, no secondary bleeding, and no inflammation. Adverse events, including local swelling, pain, and slow healing of the bleeding site with atrophy of the nasal mucosa, were more frequent in those who were given foam nasal packing rather than fibrin glue spray.
Fibrin glue has also been used experimentally to deliver a high concentration of drug to a local site, as in the example of the use of losartan to prevent neointimal hyperplasia in pig saphenous artery [ ].
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