Editor,—Elford and colleagues recently described rapid and spectacular thrombotic occlusion of an iatrogenic axillary artery pseudoaneurysm following injection of thrombin.1 The authors concluded that this treatment is “safe” and that it should be considered as the treatment of choice for iatrogenic pseudoaneurysm. Although we agree that thrombin injection is promising, there are important safety issues to address before this treatment can be adopted routinely.

There are little safety data on the immunological effects of these products. Fibrinogen/thrombin products are widely used to help achieve haemostasis during complex cardiac surgery. A recent study of 21 patients undergoing cardiothoracic surgery with fibrin glue (bovine fibrinogen clotted with bovine thrombin) demonstrated IgM and IgG antibodies …