Safety and efficacy of currently available fibrin tissue adhesives

Purpose: The purpose of this study is to review preparation methods, bonding power, preparation time, and costs associated with currently available autologous and homologous fibrin tissue adhesive preparations. Methods: Two autologous fibrin tissue adhesive preparations (AFTA-A and AFTA-E), a single-donor homologous preparation, and 2 multiple-donor pooled homologous fibrin tissue adhesives, Vi-Guard and Tisseel, were evaluated and compared in relation to bonding power, preparation time, cost, bicompatability, and biodegradability. Results: Vi-Guard and Tisseel showed significantly greater bonding strengths than their single-donor counterparts. AFTA-C offers the quickest preparation time. All preparations were found to be similar in biocompatability and biodegradability in soft tissue tests. Histology showed no infection or tissue reaction from adhesive exposure in any of the preparations. Conclusion: The optimal choice of a fibrin tissue adhesive is determined by the particular clinical indication. Currently available fibrin tissue adhesives vary appreciably in their bonding strength, cost, level of exposure risk, and preparation methods and times. Autologous preparations, which offer optimal safety, lack the strength and availability characteristics found with the multiple-donor preparations.