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Fibrin sealant

Arthur J Silvergleid, MD
Elizabeth Peralta, MD
Section Editors
Steven Kleinman, MD
Hilary Sanfey, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Fibrin sealant, or fibrin "glue," is a unique surgical hemostatic/sealant/adhesive material that is being used with increasing frequency in a variety of surgical situations. In practice, it is a two-component system in which a solution of concentrated fibrinogen and factor XIII are combined with a solution of thrombin and calcium to form a coagulum, simulating the final stage of the clotting cascade. Once the thrombin/calcium is combined with the fibrinogen/factor XIII, a fibrin clot forms in seconds, or somewhat slower if a more dilute form of thrombin is used. In some preparations, or in selected indications, an antifibrinolytic agent is included, presumably to prevent lysis of the clot [1,2]. In another preparation, chromatographic filtering techniques are used to reduce the amounts of plasminogen in the product, eliminating the need for any antifibrinolytic.

Commercially prepared fibrin sealants, including Tisseel, Beriplast, and Biocol have been used extensively in Europe for over 30 years. During much of this time, these products were not commercially available in the United States due to the reluctance of the Food and Drug Administration (FDA) to approve fibrinogen prepared from pooled human plasma, given the previously demonstrated increased risk of hepatitis transmission [3]. Instead, cryoprecipitate, prepared from a single (autologous or allogeneic) donor, most often served as the fibrinogen source in the United States. However, in 1998, the FDA approved the first commercial fibrin sealant, Tisseel.

The use of fibrin sealant will be discussed here. Reviews of other agents used primarily for the purpose of reducing bleeding by causing blood to clot, sealing vessels, or gluing tissues are discussed separately (table 1) [4,5]. (See "Overview of topical hemostatic agents and tissues adhesives used in surgery".)


The search for the perfect operative sealant began in the first decade of the 20th century. By the 1940s, fibrinogen and thrombin were combined in operative settings. When Cohn fractionation led to the ability to generate highly concentrated fibrinogen preparations (in the 1960s), fibrin sealants were used to promote wound healing, skin grafting, and dural sealing; to provide hemostasis in microvascular surgery and parenchymal injury; and to serve as a matrix for bony chips and fragments in the repair of bone defects [6].

Much of the literature generated during the past 30 years has come from Europe, but later studies have also been performed in the United States as well as Asia. Although many early studies were anecdotal or lacking a reasonable control group, it appeared that fibrin sealant systems were effective for controlling slowly bleeding foci, diffuse oozing, bleeding from needle puncture sites, lymphatic leaks, serous fluid collections, and diffuse parenchymal organ hemorrhage [7,8].


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Literature review current through: Sep 2016. | This topic last updated: Feb 26, 2016.
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