Introduction

As the gatekeepers to our formularies, we as pharmacists make decisions every day that affect both our institutions and our patients. We have to balance the costs of every product—as they relate to acquisition, storage, and use—with other considerations such as medical staff desires and product availability. We maintain our currentness with new drug releases and the latest regulatory changes, as well as an up‐to‐date knowledge of trends and developments in pharmaceutical research, in order to provide our patients and clinical staff the best possible therapeutic options. When choosing agents from within a specific class, the choice may be guided by many factors, especially when the efficacy is comparable within the class. An illustrative example of this is topical thrombin. Endogenous thrombin plays a central role in the maintenance of hemostasis. Topical thrombin was developed to take advantage of this central role as an adjunct to other methods for maintaining surgical‐field hemostasis. As a standalone agent or as part of a larger whole, thrombin is used extensively in the surgical theater across a wide range of specialties, but it is especially common in cardiovascular and spinal procedures. It is so much a part of the surgical landscape that its use is often not reported in a patient's medical records. In addition, because thrombin may be a component of another product, it may enter an institution through central surgical supply budgets rather than as a part of the pharmacy's formulary budget.