Fibrinogen and Bleeding in Adult Cardiac Surgery: A Review of the Literature

Abstract

Background: Fibrinogen is a substrate for blood clots formation. In cardiac surgery, a number of different mechanisms lead to a decrease in fibrinogen levels and consequent impaired haemostasis. Patients undergoing cardiac surgery are therefore frequently exposed to blood loss and allogeneic blood transfusion, which are risk factors associated with morbidity and mortality. Thus, particular efforts in fibrinogen management should be made to decrease bleeding and the need for blood transfusion. Therefore, fibrinogen remains an active focus of investigations from basic science to clinical practice. This review aims to summarise the latest evidence regarding the role of fibrinogen and current practices in fibrinogen management in adult cardiac surgery. Methods: The PubMed database was systematically searched for literature investigating the role and disorders of fibrinogen in cardiac surgery and diagnostic and therapeutic procedures related to fibrinogen deficiency aimed at reducing blood loss and transfusion requirements. Clinical trials and reviews from the last 10 years were included. Results: In total, 146 articles were analysed. Conclusion: The early diagnosis and treatment of fibrinogen deficiency is crucial in maintaining haemostasis in bleeding patients. Further studies are needed to better understand the association between fibrinogen levels, bleeding, and fibrinogen supplementation and their impacts on patient outcomes in different clinical settings.

Coagulation and Transfusion Updates From 2021

“…The impact of cardiopulmonary bypass on dilution, consumption, and loss of coagulation factors, including fibrinogen, is well-known. 35 Fibrinogen levels may decrease by as much as 50%, and concentrations below 200 mg/dL may be associated with impaired hemostasis. 35,36 The restoration of adequate fibrinogen levels with fibrinogen concentrates in this situation remains off-label in the United States.…”

“…35 Fibrinogen levels may decrease by as much as 50%, and concentrations below 200 mg/dL may be associated with impaired hemostasis. 35,36 The restoration of adequate fibrinogen levels with fibrinogen concentrates in this situation remains off-label in the United States. Although rare in cardiac surgery, an on-label indication was reported recently in a young woman with congenital afibrinogenemia undergoing pulmonary thromboendarterectomy with deep hypothermic circulatory arrest.…”

Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients

“…Cardiac surgery is a major consumer of blood products globally [ 1 , 2 ]. In Australia, it is the most significant surgical indication for fresh frozen plasma (FFP) and platelet (PLTS) transfusion [ 3 ].…”