Fibrin glue

This glue is used as a supportive treatment in surgery (such as liver surgery) for the improvement of hemostasis where standard surgical techniques are insufficient or impractical. It is also used for repairing dura mater tears and bronchial fistulas and for achieving hemostasis after spleen and liver trauma, as well as for skin graft donor site wounds to reduce postoperative pain. It can also be used to treat pilonidal sinus disease but it is of unclear benefit as of 2017, due to insufficient research. ==Contraindications==

The glue must not get into blood vessels, as this could lead to clotting in the form of thromboembolism or disseminated intravascular coagulation, or to anaphylaxis (a severe allergic reaction). ==Side effects==

Possible adverse effects include bleeding disorder and allergic reactions such as flushing, stinging, generalised urticaria, angioedema, bronchospasm, and anaphylaxis. Other adverse effects in studies occurred in roughly equal proportions in treatment and placebo groups. == Interactions ==

As fibrin glue contains proteins, it may be denatured by ethanol, iodine and heavy metals. These substances are frequently found in antiseptic solutions. ==Pharmacology==

Mechanism of action Thrombin is an enzyme that splits fibrinogen into fibrin monomers in 10 to 60 seconds, which aggregate to form a three-dimensional gel-like structure. Thrombin also activates factor XIII from the human body to factor XIIIa, which then cross-links the fibrin monomers to form a stable clot. Both these processes need calcium to work. As the wound heals, the clot is slowly degraded by the enzyme plasmin. Pharmacokinetics In rabbit studies, only 1 to 2% of the applied thrombin dose reached the bloodstream. It reached highest blood plasma concentrations after 6 to 8 hours. ==Chemistry==

Composition Fibrin glue comes in two vials, respectively containing: • fibrinogen: lyophilised pooled human concentrate • thrombin: This used to be of bovine origin; modern formulations contain human thrombin. The formulations also contain calcium salts. == Legal status ==

A formulation with human thrombin was approved for medical use in the United States in March 2003, and in the European Union in October 2008. == References ==