Plasma fibrinogen level on admission to the intensive care unit is a powerful predictor of postoperative bleeding after cardiac surgery with cardiopulmonary bypass

Kindo, Michel; Minh, Tam Hoang; Gerelli, Sébastien; Perrier, Stéphanie; Meyer, Nicolás; Schaeffer, Mickaël; Bentz, Jonathan; Announe, Tarek; Mommerot, Arnaud; Collange, Olivier; Pottecher, Julien; Cristinar, Mircea; Thiranos, J.-C.; Gros, Hubert; Mertès, Paul-Michel; Billaud, Philippe; Mazzucotelli, Jean‐Philippe

doi:10.1016/j.thromres.2014.05.008

Cited by 46 publications

(40 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Low levels of fibrinogen have already previously been identified as a predictor of postoperative bleeding after cardiac surgery in patient populations who were not receiving oral anticoagulation. 16,17 Thus, our finding provides support for this conclusion in a patient population with oral anticoagulation. Taken together, these results suggest that transfusion or bleeding risk may be more related to fibrinogen levels rather than INR.…”

Section: Discussionsupporting

confidence: 81%

Cardiac surgery and phenprocoumon therapy— Is preoperative normalization of the international normalized ratio necessary?

Essa

Amorim

Färber

et al. 2016

Cardiovascular and Thoracic Open

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 81%

Cardiac surgery and phenprocoumon therapy— Is preoperative normalization of the international normalized ratio necessary?

Essa

Amorim

Färber

et al. 2016

Cardiovascular and Thoracic Open

View full text Add to dashboard Cite

show abstract

“…Interestingly, the extent to which both fibrinogen concentration and FIBTEM MCF decreased is comparable with the observed increase in PT; however, unlike PT, low fibrinogen concentration has been suggested to be predictive of increased bleeding in cardiac surgery. [19][20][21][22] Fibrinogen is the first coagulation factor to reach critical levels during massive bleeding, 23 and point-of-care-guided hemostatic therapy, such as fibrinogen concentrate, to replenish fibrinogen levels is recommended in complex cardiovascular surgery. 24 Indeed, while primary hemostasis is also affected, various studies showed that fibrinogen has the strongest decline during CPB, and replacement therapy with fibrinogen concentrate was reported to be effective and well tolerated.…”

Section: Discussionmentioning

confidence: 99%

A Snapshot of Coagulopathy After Cardiopulmonary Bypass

Höfer

Fries

Solomon

et al. 2016

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Cardiac surgery involving cardiopulmonary bypass (CPB) is often associated with important blood loss, allogeneic blood product usage, morbidity, and mortality. Coagulopathy during CPB is complex, and the current lack of uniformity for triggers and hemostatic agents has led to a wide variability in bleeding treatment. The aim of this review is to provide a simplified picture of the data available on patients' coagulation status at the end of CPB in order to provide relevant information for the development of tailored transfusion algorithms. A nonsystematic literature review was carried out to identify changes in coagulation parameters during CPB. Both prothrombin time and activated partial thromboplastin time increased during CPB, by a median of 33.3% and 17.9%, respectively. However, there was marked variability across the published studies, indicating these tests may be unreliable for guiding hemostatic therapy. Some thrombin generation (TG) parameters were affected, as indicated by a median increase in TG lag time of 55.0%, a decrease in TG peak of 17.5%, and only a slight decrease in endogenous thrombin potential of 7%. The most affected parameters were fibrinogen levels and platelet count/function. Both plasma fibrinogen concentration and FIBTEM maximum clot firmness decreased during CPB (median change of 36.4% and 33.3%, respectively) as did platelet count (44.5%) and platelet component (34.2%). This review provides initial information regarding changes in coagulation parameters during CPB but highlights the variability in the reported results. Further studies are warranted to guide physicians on the parameters most appropriate to guide hemostatic therapy.

show abstract

“…77 In a prospective, observational study of 1956 patients undergoing cardiac surgery, fibrinogen levels on ICU admission were lower in bleeding patients (2.5 6 0.8 g/L and 2.1 6 0.8 g/L in the control and excessive bleeding groups, respectively) and were a predictor of bleeding. 78 Studies also suggest fibrinogen repletion will reduce bleeding and the need for allogeneic blood products. 79 A prospective study of fibrinogen concentrates in 61 patients with bleeding post-CPB noted fibrinogen reduced transfusions compared with placebo (2 U vs 13 U, respectively), and transfusion avoidance was achieved in half of the patients.…”

Section: Cardiovascular Surgerymentioning

confidence: 99%

How I use fibrinogen replacement therapy in acquired bleeding

Levy

Goodnough

2015

Blood

135

View full text Add to dashboard Cite

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.

show abstract

Plasma fibrinogen level on admission to the intensive care unit is a powerful predictor of postoperative bleeding after cardiac surgery with cardiopulmonary bypass

Cited by 46 publications

References 25 publications

Cardiac surgery and phenprocoumon therapy— Is preoperative normalization of the international normalized ratio necessary?

Cardiac surgery and phenprocoumon therapy— Is preoperative normalization of the international normalized ratio necessary?

A Snapshot of Coagulopathy After Cardiopulmonary Bypass

How I use fibrinogen replacement therapy in acquired bleeding

Contact Info

Product

Resources

About