Background. Fibrin sealant became the first modern era material approved as a hemostat in the United States in 1998. It is the only agent presently approved as a hemostat, sealant, and adhesive by the Food and Drug Administration (FDA). The product is now supplied as patches in addition to the original liquid formulations. Both laboratory and clinical uses of fibrin sealant continue to grow. The new literature on this material also continues to proliferate rapidly (approximately 200 papers/year). Methods. An overview of current fibrin sealant products and their approved uses and a comprehensive PubMed based review of the recent literature (February 2012, through March 2013) on the laboratory and clinical use of fibrin sealant are provided. Product information is organized into sections based on a classification system for commercially available materials. Publications are presented in sections based on both laboratory research and clinical topics are listed in order of decreasing frequency. Results. Fibrin sealant remains useful hemostat, sealant, and adhesive. New formulations and applications continue to be developed. Conclusions. This agent remains clinically important with the recent introduction of new commercially available products. Fibrin sealant has multiple new uses that should result in further improvements in patient care. 1. Introduction Fibrin sealant is a two-component material consisting of fibrinogen and thrombin. In the presence of small amounts of calcium and factor XIII, the thrombin converts fibrinogen into insoluble fibrin, the final stable form of the agent. Fibrin sealant now has over a century of development and use. Bergel used fibrin first as a hemostat in 1909 [1], Young and Medawar used it as an adhesive in 1940 [2], Matras used concentrated fibrinogen for nerve attachment in 1972 [3], and the Food and Drug Administration (FDA) approved liquid fibrin sealant in 1998 [4, 5] as well as a fibrin sealant patch in 2010 [6, 7]. Although straightforward, a few clear definitions are important in this area. A hemostat causes blood to clot and usually is not effective unless blood is present in the operative field. A sealant creates a sealing barrier that prevents the leakage of gas or liquid from a structure. It polymerizes on its own and is often most effective in a dry field. An adhesive is capable of gluing structures together. It is also self-polymerizing and usually most effective in a dry field. Both sealants and adhesives when applied to potentially leaking blood vessels may have a hemostatic effect by blocking holes in the
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