Link 4: Thrombin injection

Complications: Coronary perforation

Please consult the procedures specific to a thrombin injection.

Thrombin:

• Potent platelet activator
• Direct and potent promoter of fibrin clot formation

Preparation:

• Use the wire lumen of a very small diameter over-the-wire balloon catheter
• Prepare thrombin, mixed at a concentration of 50–100 IU per ml in normal saline
• Slowly inject 100–300 IU of thrombin via the distal lumen of the inflated balloon catheter over a period of 3–5 min
• Allow balloon to remain inflated for an additional 10–15 min if possible

Trick:

• Very small (approx. 0.5ml) bolus of air can be injected through the microcatheter to further diminish retrograde movement of thrombin
• Mix of thrombin with a small amount of contrast to allow visualisation of delivery within the perforated segment (injection through Corsair catheter)
• Thombin: Can be stocked in the catheterisation laboratory and is easy to mix
• Dilution: 50 to 100 IU per ml
• Injection: 50 to 500 IU per ml
• Microcatheter; Corsair; Wire lumen of very small diameter over-the-wire balloon catheters

References

1. Case report (Fischel et al, Cardiovasc Revasc Med. 2011)
   Case of perforated diagonal branch too small for balloon catheter and use of a microcatheter (1.9Fr EV3 microcatheter (Microtherapeutics, Irvine, CA)
   Concentration of 100 IU/ml; total delivered thrombin dose of 550 IU
2. Case report (Merkel et al, Clin Res Cardiol. 2011)
   Concentration of 100 IU per ml and applied dose of 50 IU (via an OTW balloon after blocking the balloon proximally to the perforation site)
3. Case report (Kotsia et al, J Invasive Cardiol. 2014)

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