News | August 03, 2008

Warning Issued For Injecting Topical Thrombin Intravascularly

August 4, 2008 - The Institute for Safe Medication Practices (ISMP) recently warned about the dangers of accidentally giving topical thrombin intravascularly, since some packages come with a syringe.

Thrombin applied topically can help stop oozing blood and minor bleeding from capillaries and small veins. Some thrombin products are produced as a frozen solution. Others come as a powder to be reconstituted, sometimes packaged with a parenteral syringe to help prepare and withdraw the product. Due to its clotting action, topical thrombin should only be applied to the surface of bleeding tissue. It should never be injected systemically, because that can lead to extensive intravascular clotting and death. ISMP points out that topical thrombin has been mistaken for parenteral medication and administered intravascularly, despite labeling on the thrombin vials that warns against injecting the product.

The confusion may arise because the vial-and-syringe packaging of some topical thrombin products makes them look like parenterals. ISMP describes several events where this kind of dangerous mix-up occurred. In one case, during cardiac surgery, a labeled syringe containing topical thrombin was placed in the warming pitcher along with heparinized saline syringes of similar volume. The topical thrombin was accidentally given intravenously instead of the heparin. The patient survived, but required additional monitoring and an extended hospital stay. 
In another example, a hospitalized patient was accidentally given topical thrombin 5,000 units intravenously. Soon afterward, the patient developed cardiopulmonary arrest and could not be resuscitated.

ISMP lists a number of ways to reduce the risk of these kinds of accidents, including:

- Have the pharmacy prepare, label, and dispense the drug whenever possible, including doses used in the OR.

- Never leave a topical thrombin vial or syringe at the patient’s bedside, because it may be confused as a parenteral product. 

- Add auxiliary warning labels to syringes containing topical thrombin. ISMP recommends repeating the warning that appears on the cartons and vials: “For topical use only - do not inject.”

- If appropriate for the type of surgery, consider using solutions of topical thrombin that can be used with an absorbable gelatin sponge. It may also be helpful to apply a dry form of topical thrombin on oozing surfaces. 

- Consider using spray kits, which are available for some topical thrombin products. The spray mechanism can help differentiate the topical thrombin from parenteral products. But never leave reconstituted topical thrombin in an unlabeled syringe before you attach the spray mechanism.

For more information:

Related Content

Abbott Initiates XIENCE Short DAPT Clinical Trial
News | Antiplatelet and Anticoagulation Therapies| August 03, 2017
Abbott recently announced the first patient has been enrolled in a clinical study evaluating the short-term use of...
Study Discovers Anticoagulant Drugs Are Being Prescribed Against Safety Advice
News | Antiplatelet and Anticoagulation Therapies| July 25, 2017
July 25, 2017 — A study by researchers at the University of Birmingham has shown that general practitioners (GPs) are
long-duration dual anti-platelet therapy (L-DAPT) compared to short-duration dual antiplatelet (S-DAPT) after DES stent implantation
News | Antiplatelet and Anticoagulation Therapies| July 12, 2017
June 12, 2017 — Researchers have evaluated the long-term efficacy and safety of long-duration dual anti-platelet ther
Sex-Specific Cardiovascular Drug Dosages Needed to Reduce Adverse Reactions in Women
News | Womens Healthcare| July 07, 2017
Sex-specific cardiovascular drug dosages are needed to reduce adverse reactions in women, according to a position paper...
Bayer Now Enrolling Patients for Global Pulmonary Arterial Hypertension Study
News | Hypertension| July 05, 2017
Bayer has enrolled the first patient in a global Phase IV study assessing the clinical effects of riociguat in patients...
FDA Grants Priority Review of Xarelto sNDA for 10 mg Dose
News | Antiplatelet and Anticoagulation Therapies| June 29, 2017
Janssen Research & Development LLC announced the U.S. Food and Drug Administration (FDA) accepted for Priority...
radial access, transradial access trial using anticoagulants
News | Radial Access| June 15, 2017
June 15, 2017 — In patients undergoing t...
Cost comparison between NOACs, novel oral anticoagulants
News | Antiplatelet and Anticoagulation Therapies| May 31, 2017
May 31, 2017 – The results from the first real-world, matched head-to-head study comparing all-cause healthcare costs
Data was positive from the Watchman Left Atrial Appendage Closure (LAAC) Device from the EWOLUTION registry
News | Atrial Fibrillation| May 30, 2017
May 30, 2017 — Data was positive for safety and efficacy rates of the Watchman Left Atrial Appendage Closure (LAAC) D
Statins Associated With Improved Heart Structure and Function
News | Pharmaceuticals| May 26, 2017
Statins are associated with improved heart structure and function, according to research presented at EuroCMR 2017, May...
Overlay Init