Fibrin glue achieves hemostasis in patients with coagulation disorders
H. B. Kram, R. C. Nathan, F. J. Stafford, A. W. Fleming and W. C. Shoemaker
Department of Surgery, Martin Luther King, Jr-Charles R. Drew Medical Center, Los Angeles, CA 90059.
Fibrin glue (FG), made with highly concentrated human fibrinogen and
clotting factors, was used to achieve parenchymal organ hemostasis in
patients with disordered coagulation secondary to massive transfusion,
chronic disease, and disseminated intravascular coagulation; it was
effective in controlling liver hemorrhage in seven patients and in the
performance of a splenorrhaphy in one other patient. The coagulation
profile was grossly abnormal in all patients, and the mean +/- SD
intraoperative blood loss was 5.1 +/- 4.2 L; patients received 14 +/- 10 U
of blood perioperatively. The amount of FG required to achieve hemostasis
varied directly with the extent of injury and intraoperative blood loss (r
= .84), and all patients with a blood loss greater than 4 L required at
least 25 mL of FG to stop bleeding. Two patients died postoperatively
secondary to cardiac arrest and adult respiratory distress syndrome.
Because FG does not depend on adequate platelet or clotting factor levels
to be effective, it is especially useful in patients with parenchymal organ
hemorrhage and disordered coagulation.
