We have investigated protein composition, formation and stability of clots obtained from autologuous fibrin sealants produced with commercially available devices (CryoSeal® and Vivostat®) and compared these parameters to those of the industrially produced homologous fibrin sealant Tissucol/Tisseel®.
The CryoSeal® product is a mixture of many plasma proteins; the Vivostat® product and Tissucol/Tisseel® appear as comparatively pure plasma derivatives. The products differ in their protein composition and concentrations, including their concentration in fibrin. Significant fibrin and -chain cross-linking by FXIIIa occurs only in Tissucol/Tisseel® clots. In test tubes CryoSeal® and Vivostat® (tranexamic acid-free formulation) fibrin clots liquefy within 1–2 days, but Vivostat® (tranexamic acid containing formulation) clots were stable for 4 days and showed partial liquefaction after 5 days. Tissucol/Tisseel® clots, containing the protease inhibitor aprotinin, appeared unchanged over the observation period of 5 days. In an in vitro model mimicking in vivo conditions (diffusion of protease inhibitors and proteolytic digestion) clot liquefaction occurs at day 1 for all autologous fibrin sealants clots, with an observable delay for the tranexamic acid containing Vivostat®, and day 5 for Tissucol/Tisseel® clots.
Characterization of the CryoSeal® and Vivostat® fibrin sealants and Tissucol/Tisseel® and their performance show a clear difference in biochemical properties.