A comparison of fibrin sealants in relation to their in vitro and in vivo properties

Introduction: Fibrin sealants (FS) have been used for many years to facilitate hemostasis and to provide suture support and scaling/adhesion of tissues after surgery. While their composition is similar, different formulations, application devices, and varying concentrations of key components mean that the properties of clots formed by individual FS can be diverse. Materials and methods: We performed several studies, including animal models, to compare the properties of 12 different commercially available FS/application device combinations using partial liver and kidney resection models to assess hemostatic efficacy and a novel pig skin model to measure adhesive clot strength. The quality of mixing was determined using colored spray images. Results: Although the FS tested shared the principle of combining fibrinogen and thrombin, major differences were found between the individual preparations with regard to hemostatic efficacy. Two pre-requisites for successful early hemostasis were identified-adequate clottable protein content and the ability of the application device to effectively mix the fibrinogen and thrombin components of the FS. Factor XIII activity was a key determinant in prevention of re-bleeding and premature clot lysis. Furthermore, FS lacking measurable factor XIII activity formed the weakest, softest clots. Conclusions: Clearly, all FS are not the same, and their different characteristics may potentially translate into different clinical outcomes. In our studies, while all FS tested performed well on individual parameters, Beriplast P (Aventis Behring) was the foremost FS in consistently providing early hemostasis, minimizing the risk of re-bleeding, and providing strong adhesive clots capable of resisting mechanical forces. (C) 2003 Elsevier Ltd. All rights reserved.