Onset of Action of Topical Thrombin

Topical thrombin begins working rapidly, with hemostatic effects occurring within 3-10 minutes of application.

Mechanism and Timing of Action

Topical thrombin works by converting fibrinogen to fibrin at the site of application, forming a clot and achieving hemostasis 1.
In clinical trials, more than 70% of patients achieve hemostasis within 3 minutes of topical thrombin application, with over 95% achieving hemostasis within 10 minutes 2.
Thrombin acts immediately upon contact with blood, initiating the final step in the coagulation cascade by cleaving fibrinogen to fibrin 3.

Topical thrombin is primarily used as a hemostatic agent during surgical procedures when conventional methods like suture ligation or electrocautery are insufficient for controlling diffuse surface bleeding 1.
Recombinant human thrombin (rhThrombin) demonstrates rapid hemostatic action, with clinical trials showing that more than 70% of recipients achieve hemostasis within 3 minutes of application 2.
The hemostatic effect is nearly complete (>95% effectiveness) within 10 minutes of application in most surgical settings 2.

The immediate hemostatic effect of topical thrombin persists at the application site as long as the formed clot remains intact 4.
Beyond its immediate hemostatic effects, thrombin continues to play a role in wound healing by stimulating mitogenic events through interaction with cell surface receptors 4.
The stability of thrombin activity is temperature-dependent, with cold storage better preserving its activity when prepared but not yet applied 5.

Topical thrombin is available in several forms, including recombinant human thrombin (rhThrombin), bovine-derived thrombin, and plasma-derived human thrombin 1.
Recombinant human thrombin has the advantage of avoiding the immunogenicity concerns associated with bovine thrombin while maintaining equivalent rapid hemostatic efficacy 2.
Autologous thrombin can be prepared intraoperatively from patient whole blood in approximately 30 minutes, providing a personalized hemostatic agent that avoids exposure to foreign proteins 5.

The rapid onset of action (within minutes) makes topical thrombin particularly valuable for achieving quick hemostasis during surgical procedures 2, 1.
Thrombin's effectiveness is not limited to its procoagulant properties; it also plays important roles in platelet aggregation, activation of various coagulation factors, and stimulation of wound healing 3.
When using topical thrombin, it's important to apply it directly to the bleeding site for maximum effectiveness, as its action is localized to the area of application 1.