The role of fibrin sealants in hemostasis

Hemostasis is a prerequisite for wound healing, and under normal physiologi c conditions, it is achieved by means of the coagulation cascade. However, there are a number of surgical procedures where there may be considerable b enefits to the patient, surgeon, or health-care costs if hemostasis can be achieved more efficiently. The rapid and effective control of bleeding duri ng and after surgery reduces blood loss and can help reduce postoperative c omplications. These improved outcomes can reduce the need for transfusion, with the associated risk of viral transmission, and have a positive impact on operative and hospital stay times. Fibrin sealants are surgical hemostat ic agents derived from human plasma that reproduce the final steps in the c oagulation pathway and form a stable fibrin clot. Fibrin sealants are used in a broad range of surgical procedures to assist hemostasis, including car diovascular, hepatic, and splenic surgery, gastrointestinal hemorrhage, ski n grafting, and dental extractions in anticoagulated patients. Patients wit h coagulopathies are at high risk of prolonged or excessive bleeding during or after invasive surgery, and these patients may also benefit from the us e of fibrin sealants. This article reviews the role of fibrin sealants in h emostasis, citing a number of key clinical studies that report a significan t reduction in blood loss or chest drain output after surgery with fibrin s ealant compared with controls. (C) 2001 Excerpta Medica, Inc. All rights re served.