Update on the Therapeutic use of Thrombin

We published a review in 2004 (1) which described the development and use of thrombin as a free-standing biologic. Studies on the use of thrombin in the resolution of aortic aneurysms and pseudoaneurysms continue to appear in the literature (2 -15). Publication rate is less frequent as this therapy evolves into a mature practice. Notable among these studies is one from Spanish investigators who compared bovine thrombin and human thrombin in the treatment of iatrogenic pseudoaneurysms (6). As would be expected, human thrombin is as effective as bovine thrombin for this indication. The lack of a commercial preparation of human thrombin, autologous thrombin has been used for pseudoaneurysms (16, 17) and at least one device is in development for the preparation of autologous thrombin (18). There would appear to other novel therapeutic uses of thrombin in development (19). There have been no reports of adverse reaction in the studies described above. However, there is some suggestion of neurotoxicity secondary to thrombin (20-22).

References

1. Lundblad, R.L., Bradshaw, R.A., Gabriel, D., et al., A review of the therapeutic uses of thrombin, Thrombosis and Haemostasis 91, 851-860, 2004.

2. Chandran, S., Parvaiz, A., Karim, A., et al. Ruptured left gastric artery aneurysm successfully treated by thrombin injection: case report and literature review, ScientificWorldJournal 5, 20-23, 2005

3. Silva, J.A., Stant, J., and Ramee, S.R., Endovascular treatment of massive retroperitoneal bleeding: successful balloon-catheter delivery of intra-arterial thrombin, Catheter Cardiovasc.Interv. 64, 218-222, 2005

4. Corso, R., Carrafiello, G., Rampoldi, A. et al., Pseudoaneurysm after spontaneous rupture of renal angiomyolipoma in tuberous sclerosis: successful treatment with percutaneous thrombin injection, Cardiovasc.Intervent.Radiol. 28, 262-264, 2005.

5. Kasthuri, R.S., Stivaros, S.M. ,and Gavan, D., Percutaneous ultrasound-guided thrombin injection for endoleaks: an alternative, Cardiovasc.Intervent.Radiol. 28, 110-112, 2005.

6. Vazquez, V., Reus, M., Pinero, A. et al., Human thrombin for treatment of pseudoaneurysms: comparison of bovine and human thrombin sonogram-guided injection, AJR Am.J.Roentgenol. 184, 1665-1671, 2005

7. Lujan, S., Puras, E. Cancer, S., and Perera, M., Paravertebral pseudoaneurysm thrombosed after percutaneous thrombin injection, Ann.Vasc.Surg. 19, 421-424, 2005.

8. Szopinski, P., Ciostek, P., Pleban, E., et al., Percutaneous thrombin injection to complete SMA pseudoaneurysm exclusion after failing of endograft placement, Cardiovasc.Intervent.Radiol. 28, 509-514, 2005

9. Maleux, G., Bielen, D., Heye, S., et al., Translumbar thrombin embolization of an aortic pseudoaneurysm complicating lumbar disk surgery, J.Vasc.Surg. 42, 163-167, 2005

10. Krueger, K., Zaehrigner, M., Strohe, D., et al., Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients, Radiology 236, 1104-1110, 2005

11. Schuster, R., Broumandi, D.D., Lee, A.A., Waxman, K., Percutaneous thrombin injection to treat a post-traumatic hepatic pseudoaneurysm, J.Trauma 59, 1022-1024, 2005.

12. Ghassemi, A., Javit, D., and Dillon, E.H., Thrombin injection of a pancreaticoduodenal artery pseudoaneurysm after failed attempts at transcatheter embolization, J.Vasc.Surg. 43, 618-622, 2006

13. Jamali, A.H., Lee, M.S., and Makkar, R.R., Coronary perforation after percutaneous coronary intervention successfully treated with local thrombin injection, J.Invasive Cardiol. 18, E143-E145, 2006.

14. Tsetis, D., Kochiadakis, G., Hamilos, M. et al., Ultrasound guided percutaneous thrombin injection for the treatment of post-catheterization femoral pseudoaneurysm, Hellenic J. Cardiol. 47, 112-113, 2006.

15. Corso, R. Rampoldi, A., Vercelli, R. et al., Percuteous repair of radial artery pseudoaneurysm in a hemodialysis patient using sonigraphically guided thrombin injection, Cardiovasc.Intervent.Radiol. 29, 130-132, 2006.

16. Engelke, C., Quarmby, J. Ubhayakar, G., et al., Autologous thrombin: a new embolization treatment for traumatic intrasplenic pseudoaneurysms, J.Endovasc.Ther. 9, 36-37, 2002

17. Quarmby, J.W., Engelke, C., Chitolie, A., et al., Autologous thrombin for treatment of pseudoaneurysms, Lancet 359, 946-947, 2002

18. Semple, E., Madsen, T., and Semple, J.W., Quality of thrombin produced from the patientís own plasma using the TPD, a new thrombin-producing device, J. Extra Corpor. Technol. 37, 196-200, 2005

19. Cannon, J.R., Keep, R.F., Hua, Y. et al., Thrombin preconditioning provides protection in a 6-hydroxydopamine Parkisonís disease model, Neurosciences Letter 373, 189-194, 2005.

20. Xue, M. and del Bigio, M.R., Injections of blood, thrombin, and plasminogen more severely damage neonatal mouse brain than mature mouse brain, Brain Pathol. 15, 273-280, 2005.

21. Chapman, J., Thrombin in inflammatory brain diseases, Autoimmun.Rev. 5, 528-531, 2006.

22. Fujimoto, S., Katsuki, H., Ohnishi, M. et al., Thrombin induces striatal neurotoxicity depending on mitogen-activated protein kinases pathway in vivo, Neuroscience, in press, 2006.