Thrombin

What is Thrombin

Thrombin is a hemostatic agent. It is a component of the clotting cascade and is known as factor IIa.

Thrombin is derived from prothrombin, an alpha-2-globulin produced by the liver.

Bovine and recombinant thrombin are commercially available. Potency of the thrombin products is measured in terms of the amount of thrombin required to form a clot. Solutions of different strengths may be prepared for use, depending on the severity of bleeding.

Topical thrombin is used during surgery to control incisional or surgical bleeding.

Thrombin is increasingly being used off-label to treat post-catheterization pseudoaneurysms; when used for this indication, thrombin is administered intravascularly, directly into the pseudoaneurysm via ultrasound-guided percutaneous injection.

Most data regarding the use of thrombin intravascularly involve pseudoaneurysms of the femoral artery; however, successful thromboses have been demonstrated in many other anatomical locations including the abdominal aorta, brachial artery, epigastric artery, hepatic artery, radial artery, subclavian artery, and superior mesenteric artery.

The use of thrombin for pseudoaneurysms is gaining popularity because it is less invasive than surgery and more successful than other less invasive modalities, such as ultrasound-guided compression; the success rate of thrombin for the treatment of pseudoaneurysms of the femoral artery is more than 90%, with some reports indicating an even higher rate of more than 97%. In addition, thrombin is effective in anticoagulated patients, unlike ultrasound-guided compression.

Furthermore, the complication rates, including thromboembolism and hypersensitivity reactions, have been reported to be 4% or lower.

Indications

  • pseudoaneurysms
  • surgical bleeding

For hemostasis of small vessels and capillaries associated with surgical bleeding

Side Effects

  1. anaphylactoid reactions
  2. anemia
  3. antibody formation
  4. bleeding
  5. disseminated intravascular coagulation (DIC)
  6. fever
  7. hematoma
  8. hypotension
  9. infection
  10. injection site reaction
  11. sinus tachycardia
  12. thrombocytopenia
  13. thromboembolism
  14. thrombosis
  15. urticaria

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • accidental exposure
  • bleeding
  • bovine protein hypersensitivity
  • breast-feeding
  • children
  • hamster protein hypersensitivity
  • infants
  • intravenous administration
  • parenteral administration
  • pregnancy
  • thromboembolism

Interactions

There are no drug interactions associated with Thrombin products.

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