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Topical thrombin and acquired coagulation factor inhibitors: clinical spectrum and laboratory diagnosis.

Publication ,  Journal Article
Ortel, TL; Charles, LA; Keller, FG; Marcom, PK; Oldham, HN; Kane, WH; Macik, BG
Published in: Am J Hematol
February 1994

Topical bovine thrombin preparations are used extensively in cardiovascular, neurosurgical, and otolaryngologic procedures. Patients who are treated with these topical thrombin preparations may develop antibodies to bovine coagulation factors that may cross-react with the endogenous human clotting proteins. We have identified four patients with acquired factor inhibitors following exposure to topical thrombin at Duke University Medical Center and summarize these cases in addition to 13 patients previously reported in the literature. In most cases, the inhibitor developed following a second (or subsequent) exposure to topical thrombin. The clinical course was extremely variable, ranging from totally asymptomatic to life-threatening hemorrhage. The most consistent laboratory abnormality was a prolonged bovine thrombin clotting time, which corrected, at least partially, when human thrombin was substituted for bovine thrombin. Some of these patients also developed factor V inhibitors with prolonged prothrombin and activated partial thromboplastin times. Although these patients have prolonged clotting times, they should not be considered "autoanticoagulated," since thromboembolic complications can still occur. Therapeutic intervention is largely empirical and depends on the clinical manifestations of the individual patient.

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Published In

Am J Hematol

DOI

ISSN

0361-8609

Publication Date

February 1994

Volume

45

Issue

2

Start / End Page

128 / 135

Location

United States

Related Subject Headings

  • Thrombin
  • Middle Aged
  • Male
  • Immunology
  • Humans
  • Hemorrhagic Disorders
  • Fibrin Tissue Adhesive
  • Female
  • Blood Coagulation Factors
  • Autoantibodies
 

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Ortel, T. L., Charles, L. A., Keller, F. G., Marcom, P. K., Oldham, H. N., Kane, W. H., & Macik, B. G. (1994). Topical thrombin and acquired coagulation factor inhibitors: clinical spectrum and laboratory diagnosis. Am J Hematol, 45(2), 128–135. https://doi.org/10.1002/ajh.2830450206
Ortel, T. L., L. A. Charles, F. G. Keller, P. K. Marcom, H. N. Oldham, W. H. Kane, and B. G. Macik. “Topical thrombin and acquired coagulation factor inhibitors: clinical spectrum and laboratory diagnosis.Am J Hematol 45, no. 2 (February 1994): 128–35. https://doi.org/10.1002/ajh.2830450206.
Ortel TL, Charles LA, Keller FG, Marcom PK, Oldham HN, Kane WH, et al. Topical thrombin and acquired coagulation factor inhibitors: clinical spectrum and laboratory diagnosis. Am J Hematol. 1994 Feb;45(2):128–35.
Ortel, T. L., et al. “Topical thrombin and acquired coagulation factor inhibitors: clinical spectrum and laboratory diagnosis.Am J Hematol, vol. 45, no. 2, Feb. 1994, pp. 128–35. Pubmed, doi:10.1002/ajh.2830450206.
Ortel TL, Charles LA, Keller FG, Marcom PK, Oldham HN, Kane WH, Macik BG. Topical thrombin and acquired coagulation factor inhibitors: clinical spectrum and laboratory diagnosis. Am J Hematol. 1994 Feb;45(2):128–135.
Journal cover image

Published In

Am J Hematol

DOI

ISSN

0361-8609

Publication Date

February 1994

Volume

45

Issue

2

Start / End Page

128 / 135

Location

United States

Related Subject Headings

  • Thrombin
  • Middle Aged
  • Male
  • Immunology
  • Humans
  • Hemorrhagic Disorders
  • Fibrin Tissue Adhesive
  • Female
  • Blood Coagulation Factors
  • Autoantibodies