Effects of Fibrinogen Concentrate As First-Line Therapy During Major Aortic Replacement Surgery

Rahe‐Meyer, Niels; Solomon, Cristina; Hanke, Alexander; Schmidt, Daniel; Knoerzer, Dietrich; Hochleitner, Gerald; Sørensen, Benny; Hagl, Christian; Pichlmaier, Maximilian

doi:10.1097/01.sa.0000435477.01184.40

Cited by 12 publications

(23 citation statements)

References 4 publications

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“…Maintaining fibrinogen levels is an important therapeutic target in bleeding patients, particularly in perioperative settings. [1][2][3] Early studies demonstrated that fibrinogen repletion corrected clot strength, based on viscoelastic blood testing using thromboelastography/thromboelastometry. 4 Normal fibrinogen levels are elevated during pregnancy, 5 and cases studies indicate that fibrinogen repletion may be effective in the treatment of postpartum hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Additionally, studies have been published, or are underway, that provide supporting evidence for the role of fibrinogen repletion for treating acquired coagulopathy. 1,[8][9][10] Although precise levels for fibrinogen repletion remain to be defined as a therapeutic trigger or target, we review the current evidence and provide therapeutic perspectives in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

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How I use fibrinogen replacement therapy in acquired bleeding

Levy

Goodnough

2015

Blood

141

102

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Fibrinogen is a critical protein for hemostasis and clot formation. However, transfusion guidelines have variable recommendations for maintaining fibrinogen levels in bleeding patients. An increasing number of studies support the practice of fibrinogen replacement therapy for acquired coagulopathies, and additional studies are underway. Fibrinogen therapy can be administered with cryoprecipitate or fibrinogen concentrates, and clinical practice varies according to their availability and licensing status. Fibrinogen concentrate therapy has been studied in animal models and clinical trials and supports the critical role of fibrinogen repletion in bleeding patients. Point-of-care testing will have an important role in guiding fibrinogen replacement for hemostatic therapy in clinical settings such as cardiovascular surgery, postpartum hemorrhage, and trauma. Fibrinogen therapy is an important component of a multimodal strategy for the treatment of coagulopathic bleeding.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How I use fibrinogen replacement therapy in acquired bleeding

Levy

Goodnough

2015

Blood

141

102

View full text Add to dashboard Cite

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“…However, while in other clinical settings, e.g. cardiac surgical patients some prospective trials on the use of point-of-care devices such as ROTEM® for the coagulation management have been published [29,30], studies in the special setting of trauma patients are exclusively of retrospective nature [18,20,31,32]. Thus, prospective data on these patients are still missing.…”

Section: Discussionmentioning

confidence: 99%

Impact of Implementation of Rotem on Allogenic Blood Transfusions in Trauma Patients Following ICU Admission before and after Study

2017

ARC Journal of Anesthesiology

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Material and Methods: Hemostatic therapy of multiple traumatized patients (n=62) was performed prospectively by using the ROTEM®-method and compared to a retrospectively analyzed cohort (n=109), who was treated according to conventional blood-analyses. Patients were characterized by age, body mass index (BMI), trauma injury severity scores (ISS), and Glascow Coma Scale (GCS). Evaluated parameters included the quantity of transfused blood-and coagulation-products (packed red blood cells (pRBCs), platelets (PLTs), fresh-frozen plasma (FFPs), fibrinogen (Fb), PPSB, antithrombin-III (AT-III), and tranexamic acid (TXA). In-hospital outcome was determined by presence of ARDS and multiple organ dysfunction syndrome (MODS). Logistic regression analysis was performed to identify independent influencing factors towards mortality. Results: No differences regarding demographic factors and injury severity were found between the study groups (p>0.05). However, during ICU-treatment the ROTEM®-group received less pRBCs FFPs, and PLTs (p<0.001)

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“…When the fibrinogen concentrates are used in CA with DH as first-line therapy produce both an increase in fibrinogen levels (79) and a reduction in transfusions (80).…”

Section: Coagulationmentioning

confidence: 99%

“…It seems interesting that the determination of fibrinogen assay of ROTEM (FITBEM A10) during CPB has a good correlation with post-CPB fibrinogen levels (68,94) and this would guide the treatment of early hypofibrinogenemia, which could have repercussions on the reduction of allogeneic transfusions (80).…”

Section: Coagulation Monitoringmentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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Effects of Fibrinogen Concentrate As First-Line Therapy During Major Aortic Replacement Surgery

Cited by 12 publications

References 4 publications

How I use fibrinogen replacement therapy in acquired bleeding

How I use fibrinogen replacement therapy in acquired bleeding

Impact of Implementation of Rotem on Allogenic Blood Transfusions in Trauma Patients Following ICU Admission before and after Study

Intraoperative care for aortic surgery using circulatory arrest

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