Topical agents have been developed to promote haemostasis such as microfibrillar collagen,39 bovine collagen-based composite mixed autologous plasma40 and fibrin sealants.41,42 Topical sealants are important because they seal vessels and biliary radicles and may reduce common postoperative complications, such as, bleeding and bile leakage. Tisseel (Baxter Healthcare, Deerfield Ill) and Crosseal fibrin sealant have been used in the US and Europe. Crosseal is a new-generation, virally inactivated surgical sealant formulated from a concentrate of human clotting proteins called biological active component (BAC) and a highly purified preparation of human «-thrombin (1000IU/ml). Fibrinogen is the active component. As Crosseal is human derived, the anaphylactic reactions associated with bovine sealants are avoided. A multicentre, randomised, controlled trial demonstrated that Crosseal was superior to standard treatment haemostatic agents in reducing time to haemostasis following liver resection and reducing complications following surgery.43
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