A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery

Abstract

Prophylactic fibrinogen reduces post-operative bleeding in patients undergoing coronary artery bypass graft.

The effect of acute normovolemic hemodilution on plasma fibrinogen level in coronary artery bypass grafting

“…[16,17] Recent studies have demonstrated an association between the level of fibrinogen and postoperative blood loss, [18,19] and even suggested prophylactic supplementation of fibrinogen. [20] Similarly, in our study, the patients had critical or low fibrinogen levels; however, this study was not adequately powered to detect a difference between such low percentage change. Recent guidelines have suggested that fibrinogen levels should be >200 mg/dL for sufficient clot strength.…”

Indications and Risks of Fibrinogen in Surgery and Trauma

“…In general complex cardiac surgery, the same approach was followed in a recent prospective randomized double-blind study in 116 patients. 49 Also in this study, the percentage of patients avoiding all allogeneic blood products was significantly higher (67 vs. 45%) and the amounts of RBCs, Cardiac surgery (CABG) Prophylactic preoperatively 1 g Sadeghi et al 51 Cardiac surgery (valve replacement) Moderate bleeding 4 g Tanaka et al 52 Cardiac surgery (pediatric) FIBTEM A10 5 mm 20 mL/kg FFP Nakayama et al 55 Liver transplantation FIBTEM MCF 6 mm Not specified Kirchner et al 57 Liver transplantation FIBTEM MCF 6 mm or Fibrinogen < 1 g/L 50 mg/kg Roullet et al 59 Obstetric Fibrinogen < 2 g/L Not specified Abdul-Kadir et al 70 Obstetric Fibrinogen 2 g/L 4 g Ahmed et al 76…”

“…Karlsson et al found in a small study of 20 patients that a preoperative 2 g dose of fibrinogen (vs. placebo) in patients undergoing coronary artery bypass grafting (CABG) surgery reduced postoperative blood loss and increased the Hb concentration at postoperative day 1 without effect on transfusion rate. 50 A similar approach was chosen by Sadeghi et al 51 In 60 patients undergoing CABG surgery they administered 1 g of fibrinogen (versus placebo) after anesthesia induction and found reduced postoperative bleeding. There was a trend toward fewer patients needing postoperative RBC transfusions, but the difference was not statistically significant.…”

“…There was a trend toward fewer patients needing postoperative RBC transfusions, but the difference was not statistically significant. 51 Finally, Tanaka et al studied 20 patients following valve surgery with signs of coagulopathic bleeding. 52 They compared a 4-g dose of fibrinogen versus the administration of 1 unit of apheresis platelets.…”

Over 50 Years of Fibrinogen Concentrate

“…The use of Haemocomplettan P/RiaSTAP to control bleeding and to decrease the use of allogeneic blood products during cases of acquired bleeding has been reported in a variety of clinical settings, including surgery, trauma, liver transplantation, and obstetrics. 28 – 30 , 33 , 36 – 43 Furthermore, recent systematic reviews confirm that the use of fibrinogen concentrate may reduce allogeneic blood product transfusion 44 – 46 ; however, very often the trials are of low quality with a high risk of bias. Moreover, the measured outcomes, such as transfusion requirements, may be prone to performance bias.…”