Fibrinogen levels compensation of thrombocytopenia-induced bleeding following cardiac surgery

Ranucci, Marco; Baryshnikova, Ekaterina; Ranucci, Matteo; Silvetti, Simona

doi:10.1016/j.ijcard.2017.09.157

Cited by 24 publications

(16 citation statements)

References 16 publications

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“…There was an improvement in all coagulation test parameters at Time 2 with the exception of fibrinogen levels, which decreased slightly (241 ± 54 to 236 ± 47 mg/dL). Prior investigations have described this observation but the mechanism may be secondary to release of sequestered coagulation factors and platelets following CPB 20,21 . Knowledge of this “normalization” may help guide clinicians in their management of abnormal coagulation tests in the absence of ongoing surgical bleeding.…”

Section: Discussionmentioning

confidence: 93%

Coagulation test changes associated with acute normovolemic hemodilution in cardiac surgery

et al. 2020

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Background: Patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) are at risk for coagulopathy and bleeding requiring blood product transfusion.Acute normovolemic hemodilution (ANH) is a blood conservation technique shown to reduce transfusion and bleeding associated with cardiac surgery. Despite numerous advantages, little is known about the effect of ANH on coagulation testing. Methods: Prospective observational study, 80 patients (40 controls, 40 ANH) undergoing cardiac surgery requiring CPB. Blood for coagulation testing (hemoglobin, platelet count, prothrombin time/International Normalized Ratio [PT/INR], activated partial thromboplastin time [aPTT], fibrinogen, and kaolin thromboelastography [TEG]) was collected 5 minutes after protamine (Time 1), and following ANH reinfusion (or 30 minutes after Time 1) in controls (Time 2). Results: Patients undergoing ANH had a significantly lower aPTT (−1.4 seconds 95% CI [−2.7, 0.0]; P = .044) and higher fibrinogen (+13 mg/dL [+1, +26]; P = .040) between Time 1 and Time 2 compared to controls. Additionally, the change in hemoglobin between Time 1 and Time 2 was significantly increased in the ANH group (+0.4 [+0.1, +0.8]; P = .024). The study also demonstrated a normalization of the platelet count, PT/INR, aPTT, and TEG values between Time 1 and Time 2 in control patients. Conclusions: In patients undergoing cardiac surgery requiring CPB, ANH results in significant improvements of aPTT, fibrinogen and hemoglobin values; however, the true clinical significance is questionable. In the absence of ongoing surgical bleeding, there appears to be normalization of coagulation tests (excluding fibrinogen) following CPB. K E Y W O R D S acute normovolemic hemodilution, cardiac surgery, cardiovascular research, coagulation test, perfusion, valve repair/replacement 1044 | SMITH ET AL.

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Section: Discussionmentioning

confidence: 93%

Coagulation test changes associated with acute normovolemic hemodilution in cardiac surgery

et al. 2020

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“…The up-regulation of coagulation factors II (prothrombin) (P00734), V (P12259), IX (P00740), X (P00742) and XII (P00748) observed in the GDM group as compared to uncomplicated pregnancies suggests an exaggeration of the existing hyper-coagulation state associated with pregnancy (16). The list was accompanied by the altered expression of all three fibrinogen-polypeptide chains [α (P02671), β (P02675) and γ (P02679)] probably due to a common thrombocytosis state in the GDM patients (17,18). Complement C3 (P01024), an important player in the activation of the complement system, in both, classical and alternative pathways, was found moderately overexpressed in the present study emphasizing the essential role of the immune system activation in the pathogenesis of GDM.…”

Section: Discussionmentioning

confidence: 95%

Quantitative Comparative Proteomics Reveals Candidate Biomarkers for the Early Prediction of Gestational Diabetes Mellitus: A Preliminary Study

Mavreli

Evangelinakis

Παπαντωνίου

et al. 2020

In Vivo

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Aim: To identify differentially expressed proteins (DEPs) in 1 st trimester maternal plasma between pregnant women at risk for gestational diabetes mellitus (GDM) and uncomplicated controls. Materials and Methods: Firsttrimester plasma from five women who developed GDM and five from non-diabetic ones were analyzed using isobaric tag for relative and absolute quantitation -labeled proteomics. Enzyme-linked immunosorbent assay was further applied in an independent cohort of 25 GDM cases and 25 controls for verification. Results: Prenylcysteine oxidase 1 (PCYOX1), beta-ala-his dipeptidase (CNDP1), extracellular matrix protein 1 (ECM1), basement membrane-specific heparan sulfate proteoglycan core protein (HSPG2), thrombospondin-4 (TSP-4) demonstrated significant differences in expression between the two groups (p<0.05). DEPs are mainly associated with complement and coagulation cascades. Conclusion: The reported plasma proteomic changes represent potential biomarkers for the early identification of women at risk for GDM. Future studies using larger and more diverse cohorts are necessary to assess the clinical utility of these findings.

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“…Therefore, the first target in our cardiovascular algorithm is an A5 FIB ≥ 12 mm (fibrinogen concentration ≥ 2.5 g/L) and the second target (if bleeding continues in complex cardiovascular surgery) is an A5 FIB ≥ 15 mm (fibrinogen concentration ≥ 3 g/L). An A5 FIB ≥ 12 mm (fibrinogen concentration ≥ 2.5 g/L) may compensate for thrombocytopenia (< 100/nl) or platelet dysfunction after CPB [53,70]. The dose calculation for fibrinogen concentrate or cryoprecipitate are based on the targeted increase in FIBTEM amplitude and presented in Table 2 [46,53,66,71,72].…”

Section: Korean J Anesthesiolmentioning

confidence: 99%

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Görlinger

Pérez-Ferrer

Dirkmann

et al. 2019

Korean J Anesthesiol

161

138

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Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management ('theranostic' approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration. Fig. 1. ROTEM trace ('temogram') displaying the clinically most important parameters and their informative value. FDPs: fibrin (ogen) split products. Courtesy of Klaus Görlinger, Germany.

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Fibrinogen levels compensation of thrombocytopenia-induced bleeding following cardiac surgery

Cited by 24 publications

References 16 publications

Coagulation test changes associated with acute normovolemic hemodilution in cardiac surgery

Coagulation test changes associated with acute normovolemic hemodilution in cardiac surgery

Quantitative Comparative Proteomics Reveals Candidate Biomarkers for the Early Prediction of Gestational Diabetes Mellitus: A Preliminary Study

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

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