Use of fibrin sealant as a hemostatic agent after liver biopsy in swine

PURPOSE: To determine whether fibrin sealant injected into the tract create d by liver biopsy can be used to decrease postprocedural bleeding. An innov ative delivery system was used to deploy the fibrin sealant, MATERIALS AND METHODS: Fibrin sealant is a hemostatic agent consisting of a suspension of fibrinogen and thrombin, A delivery system was devised where by fibrin sealant could be injected into the tract created by liver biopsy. Thirty swine were randomized into three groups: control (n = 10), heparin (n = 10), and warfarin (n = 10), Each swine underwent laparotomy and was ra ndomized to undergo three to five open liver biopsies with either a 14-gaug e cutting needle in conjunction with the fibrin sealant device or a standar d 14-gauge cutting needle alone, Forty-seven biopsy procedures were perform ed with the device; 64 biopsy procedures were performed without the device. Immediate blood loss per biopsy (mL) was estimated based on the size of th e blood stain on a sponge, Specimens were assessed for sample size. RESULTS: Immediate blood loss with and without the device, respectively, wa s: control, 0.1 mL, 5.4 mL; heparin, 6 mL, 7 mL; warfarin, 0.1 mL, 9.3 mL. These differences were significant (P < .01) for each group of swine. In 43 of 47 biopsies (91%), the device functioned without difficulty. There was no difference in sample size when the device was used. CONCLUSIONS: The fibrin sealant device is effective in reducing bleeding af ter open liver biopsy in anticoagulated and nonanticoagulated swine, The pr omising results suggest that a trial of percutaneous liver biopsy in swine should be considered.