Fibrin sealant is used as an adjunct to hemostasis (regulate bleeding) during surgeries in patients where the usual surgical techniques may prove to be ineffective or impractical. Fibrin sealant is indicated for use during corneal transplants where suturing is not practical, or during liver surgery as this is the primary site of coagulation factor synthesis and may not be able to produce the factors during surgery . A typical fibrin sealant is prepared by mixing thrombin (Factor IIa) and fibrinogen (Factor Ia). Factor XIII is also be present in the fibrin sealant as it stabilizes the clot by crosslinking the fibrin monomers. Also to prevent breakdown of the clot by the body (through the fibrinolytic system), aprotinin is added so that it inhibits dissolution of fibrin clot.
Fibrinogen is fractionated from the cryoprecipitate of the source plasma. It is separated from Factor VIII and VWF that co-precipitate with it. Thrombin is fractionated from the cryo-poor plasma and undergoes viral inactivation and removal steps. Both fibrinogen and thrombin undergo sterile filling and dry freezing. The sterile freeze dried powders are dissolved in water in the operating room and sprayed to the required site. The clot formed by the fibrin sealant is absorbed by the patient’s fibrinolytic system (the system that dissolves the clot or plug once bleeding stops).
- Used to control bleeding during surgeries and to speed up wound healing port-surgery
1.The fibrin sealant contains activated factor IIa or thrombin making it independent of the coagulation cascade based activation
2.Activated factor II activates Fibrinogen (Factor I) into fibrin (Factor Ia)
3.Activated factor II or thrombin also activates factor XIII into XIIIa, which assists in formation of a stable plug by crosslinking fibrin monomers
4.Aprotinin is also added to the fibrin selant to inhibits dissolution of fibrin clot by plasmin
- Panda, A., Kumar, S., Kumar, A., Bansal, R., Bhartiya, S.Fibrin glue in ophthalmology.Indian J Ophthalmol. 2009 Sep-Oct;57(5):371-9. doi: 10.4103/0301-4738.55079.