Use of bovine topical thrombin can result in acquired inhibitors to Factor V and other inhibitors. These inhibitors can cause a number of problems, including clinical bleeding.
Bovine topical thrombin is most often used as a hemostatic agent in:
(1) cardiac surgery
(2) neurosurgery
(3) orthopedic surgery
Autoantibodies may be formed against:
(1) Factor V
(2) Factor X
(3) Factor II (thrombin)
Risk factors:
(1) repeated use of the bovine topical thrombin
(2) amount of bovine Factor V in the preparation
Manifestations:
(1) prolongation of the PT and PTT that does not correct with normal plasma
(2) reduced levels of factor(s) affected by the inhibitor(s)
Complications may include:
(1) clinical bleeding, which may be refractory to therapy and which may last several weeks
(2) inability to monitor low molecular weight heparin by interference with Factor Xa assays
A human recombinant thrombin (Recothrom) is available that would be an alternative hemostatic agent that should not be immunogenic.
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