Thromboembolic events from the intraoperative use of topical gelatin and albumin-glutaraldehyde haemostatic agents

Abstract

BackgroundAn under-recognised complication of gelatin-based [GBA] and albumin-glutaraldehyde-based haemostat agents [AGA] is their potential to embolise. This review aims to collate and analyse cases reported in the literature of perioperative thromboembolic phenomena secondary to locally applied GBA and AGA agents. Methods An electronic search was performed on databases Embase, Ovid Medline, Proquest, Scopus and Pubmed. 8875 articles were reviewed from title and abstract. After exclusion criteria and duplicates were removed, 13 articles with 18 cases were included for analysis. Data extracted from each of the articles included patient demographics, surgery type, the haemostatic agent used, clinical features, radiology and pathological findings, and associated morbidity and mortality. ResultsThromboembolic events reported included fourteen secondaries to GBA and four from AGA. Cases included twelve pulmonary emboli, three peripheral emboli, two cerebral emboli and one coronary embolus. Embolic phenomena were most common following spinal orthopaedic surgery in GBA patients [43%], and Type A Aortic dissection repair in AGA patients [100%]. The application of 10ml or more of GBA was frequently reported in cases [64%]. Six cases were fatal. The time course of each event ranged from occurring intraoperatively to 45 days post-operation. ConclusionGBA and AGA agents are associated with venous and arterial embolisation and high overall mortality. GBA application over an unclear bleeding site poses a risk of arterial embolisation. Surgical fields should be dried before the application of AGA. Quantities of GBA > 10mL were frequently reported. GBA and AGA embolisation can occur anywhere from immediate to 45 days postoperatively.