A Comparison of Avitene Ultrafoam versus Gelfoam With and Without Thrombin to Effectively Control Bleeding

Topical hemostatic agents are used to stop bleeding in a wide range of surgical procedures. Many of the products currently available are not effective in controlling blood loss as quickly as desired, therefore, it has become common to soak hemostatic agents with thrombin, the enzyme that catalyzes the conversion of fibrinogen to fibrin. The preparation of thrombin requires additional preparation time and exposes the patient to a potentially hazardous reaction to the drug. The use of topical bovine thrombin preparations has occasionally been associated with the formation of antibodies against bovine thrombin and/or factor V which in some cases may cross react with human factor V, potentially resulting in factor V deficiency. Patients with antibodies to bovine thrombin preparations should not be re-exposed to these products to avoid abnormalities in hemostasis (Thrombin-JMI package insert, GenTrac, Inc., Middleton, Wisconsin 53562). The purpose of this study was to compare the effectiveness of two hemostatic agents Gelfoam, a gelatin derived from porcine skin, and Ultrafoam, a collagen which is made of lyophilized Avitene flour and water. A comparison was also made of both products soaked in thrombin. The studies were conducted in a highly controlled swine spleen laceration model, which provides data amenable to statistical analysis.