Clinical Use and Evidence for Topical Thrombin in Surgical Hemostasis

Effectiveness of Topical Thrombin and Fibrin‑Based Products

Limitations and Appropriate Indications

Integration with Adjunctive Hemostatic Strategies

Fibrin Glue Products in Surgical Procedures

Clinical Applications and Limitations

• Fibrin glues are ineffective for massive bleeding because the fibrin clot may be washed away by blood flow, and are most appropriate for prevention of re-bleeding rather than arrest of active massive hemorrhage, requiring direct application at the bleeding site 4
• Fibrin glues are particularly effective in heparinized patients undergoing cardiovascular procedures with extracorporeal circulation, as they do not require an intact hemostatic system, and are used for hemostasis and tissue sealing in virtually every surgical specialty, with well-documented effectiveness in cardiovascular surgery, ENT, and neurosurgery 4