The effects of pre- and postoperative fibrinogen levels on blood loss after cardiac surgery: a systematic review and meta-analysis

Abstract

Our meta-analysis indicated a significant but weak-to-moderate correlation between pre- and postoperative fibrinogen levels and postoperative blood loss in cardiac surgery. This moderate association calls for appropriate clinical studies on whether fibrinogen supplementation will decrease postoperative blood loss.

Factor XIII Deficiency and Thrombocytopenia Are Frequent Modulators of Postoperative Clot Firmness in a Surgical Intensive Care Unit

“…Thus, more epidemiological and comparative data on acquired fibrinogen deficiency -determined not only with viscoelastic testing but also with direct enzymatic and immunological assays in parallel -are therefore needed. Albeit that Yang et al [54] and Gielen et al [55] demonstrated the presence of a perpetual relationship between postoperative plasma fibrinogen level and the postoperative rate of bleeding, infusion of fibrinogen concentrate or cryoprecipitate did not reduce bleeding in these studies. As FXIII circulates in complex with fibrinogen (parts of it with high-affinity binding [56]) one might speculate that decreased fibrinogen concentrations are also a marker for a parallel decrease in FXIII.…”

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

“…[15] However, fibrinogen also binds to the circuit, forming a binding site for platelets, only to be activated by the leucocytes. [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.…”

O ROTEM tem a habilidade de prever sangramento em cirurgia cardíaca valvar?

“…Existem várias proteínas inibidoras que fazem esse trabalho de regulação. Elas atuam como anticoagulantes naturais 1,2 , TFPI (tissue factor pathway inhibitor) O primeiro inibidor a agir é o da via do fator tecidual, sintetizado nas células endoteliais e presente no plasma e nas plaquetas, acumulando-se no local lesado pela ativação local das plaquetas. Ele inibe os fatores Xa, VIIa e o fator tecidual 1,2 .…”

“…A heparina potencializa muito a sua ação 2,6 . A proteína C e proteína S são inibidores dos cofatores de coagulação V e VIII.…”

“…Um receptor endotelial da proteína C promove a sua ativação pelo complexo trombina-trombomodulina. A proteína C ativada também estimula a fibrinólise 1,2,4,6 .Fibrinólise é uma resposta hemostática normal à lesão vascular. O plasminogênio é convertido em plasmina por ativadores da parede vascular ou dos tecidos.…”