Use of topical bovine thrombin in an anti-coagulated rat model of hepatic injury

The need for surgical hemostasis in patients treated with anticoagulant medications is a concern. This study assessed a bovine-derived topical hemostat (FastAct, FA) using a partial hepatectomy hemorrhage model in anticoagulated rats. Ninety rats were randomly assigned to receive preoperative heparin, warfarin, or nothing (n = 30/treatment). Within each treatment group, FA, saline, direct pressure (DP), electrocautery, or nothing (n = 6/group) was applied to the hepatectomy site. Eight additional rats were used for assessment of the preoperative anticoagulant regimen. Rats that were not anticoagulated and received FA had faster clot times and less hemorrhage than those receiving DP (P < 0.05). In warfarin-pretreated rats, FA resulted in faster coagulation times than saline or DP and less hemorrhage than saline (P < 0.05). No differences were detected in heparinized rats. Across all groups, rats receiving FA lost less blood and formed clots more frequently than saline (P < 0.05). FA may be useful to treat hemorrhage from hepatic lacerations in anticoagulated patients.