Use of bovine topical thrombin can result in acquired inhibitors to Factor V and other inhibitors. These inhibitors can cause a number of problems, including clinical bleeding.


Bovine topical thrombin is most often used as a hemostatic agent in:

(1) cardiac surgery

(2) neurosurgery

(3) orthopedic surgery


Autoantibodies may be formed against:

(1) Factor V

(2) Factor X

(3) Factor II (thrombin)


Risk factors:

(1) repeated use of the bovine topical thrombin

(2) amount of bovine Factor V in the preparation



(1) prolongation of the PT and PTT that does not correct with normal plasma

(2) reduced levels of factor(s) affected by the inhibitor(s)


Complications may include:

(1) clinical bleeding, which may be refractory to therapy and which may last several weeks

(2) inability to monitor low molecular weight heparin by interference with Factor Xa assays


A human recombinant thrombin (Recothrom) is available that would be an alternative hemostatic agent that should not be immunogenic.


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