Review: Fibrin sealant: Clinical use and the development of the Universityof Virginia Tissue Adhesive Center

The utilization of fibrin sealants to augment hemostasis, seal tissues, and facilitate targeted delivery of drugs is increasing. In 1985, a hospital-b ased program was established to provide autologous and allogeneic cryopreci pitate that serves as a fibrin sealant when combined with bovine thrombin. To date, more than 4,000 patients have been treated with this product at ou r institution, with an efficacy rate greater than 90%. Collaboration among surgical services and the blood Lank fostered multispecialty expertise with this product that led, in 1997, to the establishment of the University of Virginia Tissue Adhesive Center. The Tissue Adhesive Center is a multidisci plinary center whose physician director and nursing and administrative supp ort staff facilitate basic research, laboratory investigation, and preclini cal and clinical trials with collaborators throughout the university. The T issue Adhesive Center also provides educational programs and clinical consu ltation, and tracks and participates in peer review of sealant use. The lic ensure of a commercially produced, virally inactivated, pooled-plasma fibri n sealant in May 1998 provided an alternative source of adhesive. Utilizati on of the commercial product surpassed use of the blood bank product in Apr il 1999. At present, use of the commercial product is approximately 3 times that of the blood bank-produced sealant. This report reviews the clinical uses of fibrin sealant, its regulatory history, the production of fibrin se alants, the evolution of a blood bank fibrin sealant program, the developme nt of the Tissue Adhesive Center, and the utilization of commercial and blo od bank-produced sealant at our university hospital.