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Overview of topical hemostatic agents and tissues adhesives

Elizabeth Peralta, MD
Section Editor
Hilary Sanfey, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Topical hemostatic agents and tissue adhesives are used as an adjunct or alternative to standard suturing techniques to control bleeding or for wound closure.

The mechanism of action, indications, and the clinical application of the most common topical hemostatic agents and tissue adhesives used in surgery are reviewed here. Devices used to achieve surgical hemostasis through vascular control during dissection are discussed elsewhere. (See "Overview of electrosurgery" and "Instruments and devices used in laparoscopic surgery".)


Topical hemostatic agents are used when surgical hemostasis is inadequate or impractical. The majority of routine, elective operations are performed in patients with normal hemostasis and with minimal blood loss. The two main categories of topical hemostatic agents are physical agents, which promote hemostasis using a passive substrate, and biologically active agents, which enhance coagulation at the bleeding site (table 1). (See 'Physical agents' below and 'Biologically active agents' below.)

Indications for use — Intraoperative bleeding is controlled using standard surgical techniques and electrocautery with the adjunctive use of topical hemostatic agents.

Electrocautery may not be useful for controlling bleeding in some surgical fields such as around nerves, medullary bone surfaces, needle-hole bleeding from vascular grafts, and raw areas on cut surfaces.

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Literature review current through: Nov 2017. | This topic last updated: Feb 21, 2017.
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  1. Lai A, Davidson N, Galloway SW, Thachil J. Perioperative management of patients on new oral anticoagulants. Br J Surg 2014; 101:742.
  2. Berrevoet F, de Hemptinne B. Use of topical hemostatic agents during liver resection. Dig Surg 2007; 24:288.
  3. Fischer L, Seiler CM, Broelsch CE, et al. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery 2011; 149:48.
  4. Ding H, Yuan JQ, Zhou JH, et al. Systematic review and meta-analysis of application of fibrin sealant after liver resection. Curr Med Res Opin 2013; 29:387.
  5. Vaiman M, Eviatar E, Segal S. Effectiveness of second-generation fibrin glue in endonasal operations. Otolaryngol Head Neck Surg 2002; 126:388.
  6. Eshghi P, Jenabzade A, Habibpanah B. A self-controlled comparative clinical trial to explore the effectiveness of three topical hemostatic agents for stopping severe epistaxis in pediatrics with inherited coagulopathies. Hematology 2014; 19:361.
  7. Rakocz M, Mazar A, Varon D, et al. Dental extractions in patients with bleeding disorders. The use of fibrin glue. Oral Surg Oral Med Oral Pathol 1993; 75:280.
  8. Malapert G, Hanna HA, Pages PB, Bernard A. Surgical sealant for the prevention of prolonged air leak after lung resection: meta-analysis. Ann Thorac Surg 2010; 90:1779.
  9. Niklasson A, Tano K. The Gelfoam® plug: an alternative treatment for small eardrum perforations. Laryngoscope 2011; 121:782.
  10. Mishra SR, Chander Sharma B, Kumar A, Sarin SK. Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial. Gut 2010; 59:729.
  11. Chang YJ, Park JJ, Joo MK, et al. Long-term outcomes of prophylactic endoscopic histoacryl injection for gastric varices with a high risk of bleeding. Dig Dis Sci 2010; 55:2391.
  12. Cheng CL, Liu NJ, Lee CS, et al. Endoscopic management of Dieulafoy lesions in acute nonvariceal upper gastrointestinal bleeding. Dig Dis Sci 2004; 49:1139.
  13. http://www.tisseel.com/us/clinical_evidence.html (Accessed on October 06, 2015).
  14. Sudmann B, Bang G, Sudmann E. Histologically verified bone wax (beeswax) granuloma after median sternotomy in 17 of 18 autopsy cases. Pathology 2006; 38:138.
  15. Gibbs L, Kakis A, Weinstein P, Conte JE Jr. Bone wax as a risk factor for surgical-site infection following neurospinal surgery. Infect Control Hosp Epidemiol 2004; 25:346.
  16. Vestergaard RF, Jensen H, Vind-Kezunovic S, et al. Bone healing after median sternotomy: a comparison of two hemostatic devices. J Cardiothorac Surg 2010; 5:117.
  17. Vestergaard RF, Nielsen PH, Terp KA, et al. Effect of hemostatic material on sternal healing after cardiac surgery. Ann Thorac Surg 2014; 97:153.
  18. Mannucci PM. Hemostatic drugs. N Engl J Med 1998; 339:245.
  19. Sharma JB, Malhotra M. Topical oxidized cellulose for tubal hemorrhage hemostasis during laparoscopic sterilization. Int J Gynaecol Obstet 2003; 82:221.
  20. Sharma JB, Malhotra M, Pundir P. Laparoscopic oxidized cellulose (Surgicel) application for small uterine perforations. Int J Gynaecol Obstet 2003; 83:271.
  21. Spangler D, Rothenburger S, Nguyen K, et al. In vitro antimicrobial activity of oxidized regenerated cellulose against antibiotic-resistant microorganisms. Surg Infect (Larchmt) 2003; 4:255.
  22. Wiseman DM, Kamp LF, Saferstein L, et al. Improving the efficacy of INTERCEED Barrier in the presence of blood using thrombin, heparin or a blood insensitive barrier, modified INTERCEED (nTC7). Prog Clin Biol Res 1993; 381:205.
  23. Smeets R, Ulrich D, Unglaub F, et al. Effect of oxidised regenerated cellulose/collagen matrix on proteases in wound exudate of patients with chronic venous ulceration. Int Wound J 2008; 5:195.
  24. Fagotti A, Costantini B, Fanfani F, et al. Risk of postoperative pelvic abscess in major gynecologic oncology surgery: one-year single-institution experience. Ann Surg Oncol 2010; 17:2452.
  25. Hong YM, Loughlin KR. The use of hemostatic agents and sealants in urology. J Urol 2006; 176:2367.
  26. Weaver FA, Hood DB, Zatina M, et al. Gelatin-thrombin-based hemostatic sealant for intraoperative bleeding in vascular surgery. Ann Vasc Surg 2002; 16:286.
  27. http://labeling.pfizer.com/ShowLabeling.aspx?id=573 (Accessed on June 09, 2011).
  28. Connolly R. A comparison of Avitene Ultrafoam versus Gelfoam with and without thrombin to effectively control bleeding. Surgical Research Laboratory, New England Medical Center, Boston, MA https://www.crbard.com/uploadedFiles/CorpSite/Healthcare_Professionals/UltraFoam%20Whitepaper.pdf (Accessed on October 18, 2011).
  29. Ereth MH, Schaff M, Ericson EF, et al. Comparative safety and efficacy of topical hemostatic agents in a rat neurosurgical model. Neurosurgery 2008; 63:369.
  30. Borten M, Friedman EA. Translaparoscopic hemostasis with microfibrillar collagen in lieu of laparotomy. A report of two cases. J Reprod Med 1983; 28:804.
  31. FDA December 2016 PMA Approvals http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/PMAApprovals/UCM537584.pdf (Accessed on January 30, 2017).
  32. Holub Z, Jabor A. Laparoscopic management of bleeding after laparoscopic or vaginal hysterectomy. JSLS 2004; 8:235.
  33. Tschan CA, Nie M, Schwandt E, Oertel J. Safety and efficacy of microporous polysaccharide hemospheres in neurosurgery. Neurosurgery 2011; 69:ons49.
  34. Qerimi B, Baumann P, Hüsing J, et al. Collagen hemostat significantly reduces time to hemostasis compared with cellulose: COBBANA, a single-center, randomized trial. Am J Surg 2013; 205:636.
  35. Kheirabadi BS, Edens JW, Terrazas IB, et al. Comparison of new hemostatic granules/powders with currently deployed hemostatic products in a lethal model of extremity arterial hemorrhage in swine. J Trauma 2009; 66:316.
  36. Cox ED, Schreiber MA, McManus J, et al. New hemostatic agents in the combat setting. Transfusion 2009; 49 Suppl 5:248S.
  37. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma 2006; 60:655.
  38. Rago A, Duggan MJ, Marini J, et al. Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury. J Trauma Acute Care Surg 2014; 77:73.
  39. Brown MA, Daya MR, Worley JA. Experience with chitosan dressings in a civilian EMS system. J Emerg Med 2009; 37:1.
  40. Gegel BT, Austin PN, Johnson AD. An evidence-based review of the use of a combat gauze (QuikClot) for hemorrhage control. AANA J 2013; 81:453.
  41. Choron RL, Hazelton JP, Hunter K, et al. Intra-abdominal packing with laparotomy pads and QuikClot™ during damage control laparotomy: A safety analysis. Injury 2017; 48:158.
  42. Schoenecker JG, Johnson RK, Fields RC, et al. Relative purity of thrombin-based hemostatic agents used in surgery. J Am Coll Surg 2003; 197:580.
  43. Raga F, Sanz-Cortes M, Bonilla F, et al. Reducing blood loss at myomectomy with use of a gelatin-thrombin matrix hemostatic sealant. Fertil Steril 2009; 92:356.
  44. Bak JB, Singh A, Shekarriz B. Use of gelatin matrix thrombin tissue sealant as an effective hemostatic agent during laparoscopic partial nephrectomy. J Urol 2004; 171:780.
  45. Uribe CA, Eichel L, Khonsari S, et al. What happens to hemostatic agents in contact with urine? An in vitro study. J Endourol 2005; 19:312.
  46. Chapman WC, Singla N, Genyk Y, et al. A phase 3, randomized, double-blind comparative study of the efficacy and safety of topical recombinant human thrombin and bovine thrombin in surgical hemostasis. J Am Coll Surg 2007; 205:256.
  47. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999; 57:1005.
  48. Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty. J Arthroplasty 2014; 29:387.
  49. Xu X, Xiong S, Wang Z, et al. Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials. Drug Discov Ther 2015; 9:173.
  50. Jahanshahi J, Hashemian F, Pazira S, et al. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PLoS One 2014; 9:e104477.
  51. Spegar J, Vanek T, Snircova J, et al. Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study. J Thromb Thrombolysis 2011; 32:303.
  52. Waldow T, Szlapka M, Haferkorn M, et al. Prospective clinical trial on dosage optimizing of tranexamic acid in non-emergency cardiac surgery procedures. Clin Hemorheol Microcirc 2013; 55:457.
  53. Ausen K, Fossmark R, Spigset O, Pleym H. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg 2015; 102:1348.
  54. Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev 2013; :CD010562.
  55. Lang N, Pereira MJ, Lee Y, et al. A blood-resistant surgical glue for minimally invasive repair of vessels and heart defects. Sci Transl Med 2014; 6:218ra6.
  56. Oz MC, Cosgrove DM 3rd, Badduke BR, et al. Controlled clinical trial of a novel hemostatic agent in cardiac surgery. The Fusion Matrix Study Group. Ann Thorac Surg 2000; 69:1376.
  57. Renkens KL Jr, Payner TD, Leipzig TJ, et al. A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery. Spine (Phila Pa 1976) 2001; 26:1645.
  58. Hanks JB, Kjaergard HK, Hollingsbee DA. A comparison of the haemostatic effect of Vivostat patient-derived fibrin sealant with oxidised cellulose (Surgicel) in multiple surgical procedures. Eur Surg Res 2003; 35:439.
  59. Rousou J, Levitsky S, Gonzalez-Lavin L, et al. Randomized clinical trial of fibrin sealant in patients undergoing resternotomy or reoperation after cardiac operations. A multicenter study. J Thorac Cardiovasc Surg 1989; 97:194.
  60. Achneck HE, Sileshi B, Jamiolkowski RM, et al. A comprehensive review of topical hemostatic agents: efficacy and recommendations for use. Ann Surg 2010; 251:217.
  61. Burgert JM, Gegel BT, Austin R 3rd, et al. Effects of arterial blood pressure on rebleeding using Celox and TraumaDEX in a porcine model of lethal femoral injury. AANA J 2010; 78:230.
  62. Finley DS, Lee DI, Eichel L, et al. Fibrin glue-oxidized cellulose sandwich for laparoscopic wedge resection of small renal lesions. J Urol 2005; 173:1477.
  63. Krishnan S, Conner TM, Leslie R, et al. Choice of hemostatic agent and hospital length of stay in cardiovascular surgery. Semin Cardiothorac Vasc Anesth 2009; 13:225.
  64. Vote BJ, Elder MJ. Cyanoacrylate glue for corneal perforations: a description of a surgical technique and a review of the literature. Clin Exp Ophthalmol 2000; 28:437.
  65. Chan SM, Boisjoly H. Advances in the use of adhesives in ophthalmology. Curr Opin Ophthalmol 2004; 15:305.
  66. Velazquez AJ, Carnahan MA, Kristinsson J, et al. New dendritic adhesives for sutureless ophthalmic surgical procedures: in vitro studies of corneal laceration repair. Arch Ophthalmol 2004; 122:867.
  67. Kiliç A, Ozdengil E. Skin graft fixation by applying cyanoacrylate without any complication. Plast Reconstr Surg 2002; 110:370.
  68. Schwaiger N, Wu J, Wright B, et al. BioWeld(®) Tube and surgical glue for experimental sutureless venous microanastomosis. Br J Surg 2010; 97:1825.
  69. Lumsden AB, Heyman ER, Closure Medical Surgical Sealant Study Group. Prospective randomized study evaluating an absorbable cyanoacrylate for use in vascular reconstructions. J Vasc Surg 2006; 44:1002.
  70. Testini M, Lissidini G, Poli E, et al. A single-surgeon randomized trial comparing sutures, N-butyl-2-cyanoacrylate and human fibrin glue for mesh fixation during primary inguinal hernia repair. Can J Surg 2010; 53:155.
  71. Petratos PB, Rucker GB, Soslow RA, et al. Evaluation of octylcyanoacrylate for wound repair of clinical circumcision and human skin incisional healing in a nude rat model. J Urol 2002; 167:677.
  72. Ozkan KU, Gonen M, Sahinkanat T, et al. Wound approximation with tissue glue in circumcision. Int J Urol 2005; 12:374.
  73. Cheng W, Saing H. A prospective randomized study of wound approximation with tissue glue in circumcision in children. J Paediatr Child Health 1997; 33:515.
  74. Elemen L, Seyidov TH, Tugay M. The advantages of cyanoacrylate wound closure in circumcision. Pediatr Surg Int 2011; 27:879.
  75. Kaye JD, Kalisvaart JF, Cuda SP, et al. Sutureless and scalpel-free circumcision--more rapid, less expensive and better? J Urol 2010; 184:1758.
  76. Zafar F, Thompson JN, Pati J, et al. Sutureless circumcision. Br J Surg 1993; 80:859.
  77. Dafford EE, Anderson PA. Comparison of dural repair techniques. Spine J 2015; 15:1099.
  78. Ridgway DM, Mahmood F, Moore L, et al. A blinded, randomised, controlled trial of stapled versus tissue glue closure of neck surgery incisions. Ann R Coll Surg Engl 2007; 89:242.
  79. Ozturan O, Miman MC, Aktas D, Oncel S. Butylcyanoacrylate tissue adhesive for columellar incision closure. J Laryngol Otol 2001; 115:535.
  80. Shamiyeh A, Schrenk P, Stelzer T, Wayand WU. Prospective randomized blind controlled trial comparing sutures, tape, and octylcyanoacrylate tissue adhesive for skin closure after phlebectomy. Dermatol Surg 2001; 27:877.
  81. Ong CC, Jacobsen AS, Joseph VT. Comparing wound closure using tissue glue versus subcuticular suture for pediatric surgical incisions: a prospective, randomised trial. Pediatr Surg Int 2002; 18:553.
  82. Coulthard P, Worthington H, Esposito M, et al. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev 2004; :CD004287.
  83. Matin SF. Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions. J Am Coll Surg 2003; 196:845.
  84. Chow A, Marshall H, Zacharakis E, et al. Use of tissue glue for surgical incision closure: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 2010; 211:114.
  85. Romero P, Frongia G, Wingerter S, Holland-Cunz S. Prospective, randomized, controlled trial comparing a tissue adhesive (Dermabond™) with adhesive strips (Steri-Strips™) for the closure of laparoscopic trocar wounds in children. Eur J Pediatr Surg 2011; 21:159.
  86. Kouba DJ, Tierney E, Mahmoud BH, Woo D. Optimizing closure materials for upper lid blepharoplasty: a randomized, controlled trial. Dermatol Surg 2011; 37:19.
  87. Vastani A, Maria A. Healing of intraoral wounds closed using silk sutures and isoamyl 2-cyanoacrylate glue: a comparative clinical and histologic study. J Oral Maxillofac Surg 2013; 71:241.
  88. Amin M, Glynn F, Timon C. Randomized trial of tissue adhesive vs staples in thyroidectomy integrating patient satisfaction and Manchester score. Otolaryngol Head Neck Surg 2009; 140:703.
  89. Lazar HL, McCann J, Fitzgerald CA, et al. Novel adhesive skin closures improve wound healing following saphenous vein harvesting. J Card Surg 2008; 23:152.
  90. Greene D, Koch RJ, Goode RL. Efficacy of octyl-2-cyanoacrylate tissue glue in blepharoplasty. A prospective controlled study of wound-healing characteristics. Arch Facial Plast Surg 1999; 1:292.
  91. Bernard L, Doyle J, Friedlander SF, et al. A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents. Arch Dermatol 2001; 137:1177.
  92. Ferlise VJ, Ankem MK, Barone JG. Use of cyanoacrylate tissue adhesive under a diaper. BJU Int 2001; 87:672.
  93. Lloris-Carsí JM, Ballester-Álvaro J, Barrios C, et al. Randomized clinical trial of a new cyanoacrylate flexible tissue adhesive (Adhflex) for repairing surgical wounds. Wound Repair Regen 2016; 24:568.
  94. Martin JG, Hollenbeck ST, Janas G, et al. Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement. J Vasc Interv Radiol 2017; 28:111.
  95. Dumville JC, Coulthard P, Worthington HV, et al. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev 2014; :CD004287.
  96. Epstein NE. Dural repair with four spinal sealants: focused review of the manufacturers' inserts and the current literature. Spine J 2010; 10:1065.
  97. Nicotera SP, Decamp MM. Special situations: air leak after lung volume reduction surgery and in ventilated patients. Thorac Surg Clin 2010; 20:427.
  98. Yoo J, Chandarana S, Cosby R. Clinical application of tissue adhesives in soft-tissue surgery of the head and neck. Curr Opin Otolaryngol Head Neck Surg 2008; 16:312.
  99. Pursifull NF, Morey AF. Tissue glues and nonsuturing techniques. Curr Opin Urol 2007; 17:396.
  100. Chao HH, Torchiana DF. BioGlue: albumin/glutaraldehyde sealant in cardiac surgery. J Card Surg 2003; 18:500.
  101. Khan H, Chaubey S, Desai J. Early failure of coronary artery bypass grafts: an albumin cross-linked glutaraldehyde (BioGlue) related complication. J Card Surg 2011; 26:264.
  102. Sameem M, Wood TJ, Bain JR. A systematic review on the use of fibrin glue for peripheral nerve repair. Plast Reconstr Surg 2011; 127:2381.
  103. Stone WM, Cull DL, Money SR. A randomized prospective multicenter trial of a novel vascular sealant. Ann Vasc Surg 2012; 26:1077.
  104. Allen MS, Wood DE, Hawkinson RW, et al. Prospective randomized study evaluating a biodegradable polymeric sealant for sealing intraoperative air leaks that occur during pulmonary resection. Ann Thorac Surg 2004; 77:1792.
  105. Klijian A. A novel approach to control air leaks in complex lung surgery: a retrospective review. J Cardiothorac Surg 2012; 7:49.
  106. Nakamura H, Matsuyama Y, Yoshihara H, et al. The effect of autologous fibrin tissue adhesive on postoperative cerebrospinal fluid leak in spinal cord surgery: a randomized controlled trial. Spine (Phila Pa 1976) 2005; 30:E347.
  107. Glickman M, Gheissari A, Money S, et al. A polymeric sealant inhibits anastomotic suture hole bleeding more rapidly than gelfoam/thrombin: results of a randomized controlled trial. Arch Surg 2002; 137:326.
  108. Hariprasad SM, Singh A. Polyethylene glycol hydrogel polymer sealant for vitrectomy surgery: an in vitro study of sutureless vitrectomy incision closure. Arch Ophthalmol 2011; 129:322.
  109. Eichler C, Fischer P, Sauerwald A, et al. Flap adhesion and effect on postoperative complication rates using Tissuglu® in mastectomy patients. Breast Cancer 2016; 23:486.
  110. Walgenbach KJ, Bannasch H, Kalthoff S, Rubin JP. Randomized, prospective study of TissuGlu® surgical adhesive in the management of wound drainage following abdominoplasty. Aesthetic Plast Surg 2012; 36:491.
  111. Eichler C, Dahdouh F, Sauerwald A, Warm M. Seroma suppression using TissuGlu® in a high-risk patient post-mastectomy: a case report. J Med Case Rep 2013; 7:138.
  112. Eichler C, Dahdouh F, Fischer P, Warm M. No-drain mastectomy - Preventing seroma using TissuGlu(®): A small case series. Ann Med Surg (Lond) 2014; 3:82.
  113. Edwards SJ, Crawford F, van Velthoven MH, et al. The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms. Health Technol Assess 2016; 20:1.
  114. Olsen PS, Hjelms E. Intravascular air after fibrin sealing by spray gun in cardiovascular surgery. Eur J Cardiothorac Surg 1989; 3:376.
  115. Umegaki T, Nishi K, Murao K, et al. [Lethal air embolism after spray of tissue adhesive-fibrinogen and factor XIII aerosol during laparoscopic partial nephrectomy]. Masui 2007; 56:1203.
  116. Ebner FM, Paul A, Peters J, Hartmann M. Venous air embolism and intracardiac thrombus after pressurized fibrin glue during liver surgery. Br J Anaesth 2011; 106:180.
  117. Felema GG, Bryskin RB, Heger IM, Saswata R. Venous air embolism from Tisseel use during endoscopic cranial vault remodeling for craniosynostosis repair: a case report. Paediatr Anaesth 2013; 23:754.
  118. Nakajima M, Kamei T, Tomimatu K, Manabe T. An intraperitoneal tumorous mass caused by granulomas of microfibrillar collagen hemostat (Avitene). Arch Pathol Lab Med 1995; 119:1161.
  119. Edmonson MB. Foreign body reactions to dermabond. Am J Emerg Med 2001; 19:240.
  120. Narakas A. The use of fibrin glue in repair of peripheral nerves. Orthop Clin North Am 1988; 19:187.
  121. Ochsner MG, Maniscalco-Theberge ME, Champion HR. Fibrin glue as a hemostatic agent in hepatic and splenic trauma. J Trauma 1990; 30:884.
  122. Milde LN. An anaphylactic reaction to fibrin glue. Anesth Analg 1989; 69:684.
  123. Kitamura K, Yasuoka R, Ohara M, et al. How safe are the xenogeneic hemostats?--Report of a case of severe systemic allergic reaction. Surg Today 1995; 25:433.
  124. Kawamura M, Sawafuji M, Watanabe M, et al. Frequency of transmission of human parvovirus B19 infection by fibrin sealant used during thoracic surgery. Ann Thorac Surg 2002; 73:1098.
  125. Reiss RF, Oz MC. Autologous fibrin glue: production and clinical use. Transfus Med Rev 1996; 10:85.
  126. Oz MC, Jeevanandam V, Smith CR, et al. Autologous fibrin glue from intraoperatively collected platelet-rich plasma. Ann Thorac Surg 1992; 53:530.
  127. Quigley RL, Perkins JA, Gottner RJ, et al. Intraoperative procurement of autologous fibrin glue. Ann Thorac Surg 1993; 56:387.
  128. Ferschl MB, Rollins MD. Thromboemboli, acute right heart failure and disseminated intravascular coagulation after intraoperative application of a topical hemostatic matrix. Anesth Analg 2009; 108:434.
  129. Ortel TL, Mercer MC, Thames EH, et al. Immunologic impact and clinical outcomes after surgical exposure to bovine thrombin. Ann Surg 2001; 233:88.
  130. Randleman CD Jr, Singla NK, Renkens KL, et al. Persistence of antibodies to the topical hemostat bovine thrombin. J Am Coll Surg 2010; 211:798.