A Phase 3, Randomized, Double-Blind Comparative Study of the Efficacy and Safety of Topical Recombinant Human Thrombin and Bovine Thrombin in Surgical Hemostasis - 19/08/11
Correspondence address: William C Chapman, MD, Washington University, Department of Surgery, Section of Transplantation, 660 South Euclid Ave, Campus Box 8109, Room 6107 Queeny Tower, St Louis, MO 63110.Riassunto |
Background |
Plasma-derived bovine thrombin is used as a topical agent to improve surgical hemostasis, but development of antibodies to bovine hemostatic proteins has been associated with increased bleeding and thrombotic complications. Recombinant human thrombin could reduce the risk of these complications.
Study Design |
The objective of this randomized, double-blind, comparative trial was to compare the efficacy, safety, and antigenicity of recombinant human thrombin (rhThrombin) and bovine thrombin as adjuncts to hemostasis in liver resection, spine, peripheral arterial bypass, and dialysis access surgery. Blinded study drug was applied topically to bleeding sites with an absorbable gelatin sponge. The primary efficacy end point was time to hemostasis, summarized as the incidence of hemostasis within 10 minutes. Safety analyses were conducted for 1 month after operation, and the development of antibodies to rhThrombin or to the bovine product was evaluated.
Results |
Four hundred one patients completed this trial. Hemostasis was achieved at the time-to-hemostasis evaluation site within 10 minutes in 95% of patients in each treatment group. Overall complications, including operative mortality, adverse events, and laboratory abnormalities, were similar between groups. Forty-three (21.5%) patients receiving bovine thrombin developed antibodies to the product; three patients (1.5%; p < 0.0001) in the rhThrombin group developed antibodies to rhThrombin. None of the three patients who developed antirhThrombin antibodies had abnormal coagulation laboratory results or bleeding, thromboembolic, or hypersensitivity events.
Conclusions |
Results of this trial suggest that rhThrombin has comparable efficacy, a similar safety profile, and is considerably less immunogenic than bovine thrombin when used for surgical hemostasis.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations and Acronyms : bThrombin, INR, PAB, PT, rhThrombin, TTH
Mappa
| Competing Interests Declared: Authors Murphy and Reynolds were employees of ZymoGenetics, the sponsor of the trial; during the entire study. They are no longer employees of ZymoGenetics. Funding for this trial was provided by ZymoGenetics, Inc. Trial Registration: This study is registered with ClinicalTrials.gov with the identifier NCT00245336. |
Vol 205 - N° 2
P. 256-265 - agosto 2007 Ritorno al numero
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