Potential Complications Allergic

The use of hemostatic agents implies potential risks of allergic reactions because bovine thrombin is immunogenic. Sudden and severe hypotension resulting in death has been reported after applying bovine thrombin to a deep hepatic wound (48), and immune-mediated coagulopathy from bovine thrombin is a well-recognized complication (49-51).

Exposure to bovine thrombin may result in the formation of antibovine thrombin immunoglobulin E antibodies. Upon reexposure, such antibodies may cross react with human thrombin and cause anaphylaxis, coagulopathy, or hypercoagulability (52,53).

Recent commercial preparations have replaced bovine thrombin with human thrombin (Tisseel and Crosseal).

■ Some products still contain bovine thrombin (Costasis, Floseal) or bovine-derived materials such as aprotinin (Tisseel) or collagen (Floseal).

■ To avoid adverse outcomes, products containing bovine protein should be contraindicated in patients with known allergy hypersensitivity reactions.

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