Clinical Simulation Model of Fibrinogen Decline During Hemorrhage in Major Noncardiac Surgery

Kikura, Mutsuhito; Nishino, Junko; Uraoka, Masahiro

doi:10.1016/j.jss.2020.12.008

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…They also found that the effect of fibrinogen concentrate on reducing blood loss and transfusion volume was clear in patients with FIBTEM A10 < 6 mm at the time of weaning from cardiopulmonary bypass, while in patients with FIBTEM A10 > 6 mm, hemostatic capacity was high and FFP was sufficient [11]. In addition to these viscoelastic devices, new techniques for rapid measurement and estimation of fibrinogen levels have recently been developed in Japan [12,13]. Although there are limitations in the interpretation and these rapid measurements of fibrinogen levels, it is hoped that rapid measurement of fibrinogen levels will become more widespread in the future, as fibrinogen levels themselves remain an important guideline for evaluating patients with bleeding [14].…”

Section: Discussionmentioning

confidence: 99%

Effect of cryoprecipitate on an increase in fibrinogen level in patients with excessive intraoperative blood loss: a single-center retrospective study

2022

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Background Cryoprecipitate, which contains fibrinogen and factor VIII in large quantities, is concentrated from fresh frozen plasma, and it has hemostatic effects in severe bleeding. We retrospectively examined the effects of cryoprecipitate on the increase in fibrinogen levels in patients with excessive intraoperative blood loss. Methods Ninety-seven patients who were administered cryoprecipitate during surgery between June 2014 and May 2019 were enrolled in our study and categorized according to the volume of intraoperative blood loss as follows: group A, 2000–5000 mL; group B, 5000–10,000 mL; group C, > 10,000 mL. Data were extracted from electronic medical records and electronic anesthesia records. The primary endpoint was an increase in the fibrinogen level after the administration of cryoprecipitate. Results Nine patients with no fibrinogen data and four patients with a bleeding volume of less than 2000 mL were excluded; thus, 84 patients (A: n = 36, B: n = 37, C: n = 11) were evaluated. The mean intraoperative blood loss (mL) in groups A, B, and C were 3348 ± 791, 6688 ± 1225, and 14,281 ± 5142, respectively. The fibrinogen levels (mg/dL) before cryoprecipitate administration in groups A, B, and C were 189 ± 94, 113 ± 42, and 83 ± 29, respectively (p < 0.05 among the groups). The increase in fibrinogen level (mg/dL) after cryoprecipitate administration in group C was significantly greater than that in group A (84 ± 34 versus 50 ± 36, p < 0.01). Conclusions The results of this study indicate that the effect of cryoprecipitate on the increase in fibrinogen level was most apparent in patients with excessive intraoperative blood loss ≥ 10,000 mL. In addition, most patients with intraoperative blood loss ≥ 5000 mL had fibrinogen levels < 150 mg/dL which improved to ≥ 150 mg/dL after cryoprecipitate administration in approximately 70% of patients. Therefore, cryoprecipitate administration should be considered for patients with hypofibrinogenemia (≤ 150 mg/dL) experiencing severe bleeding (e.g., ≥ 5000 mL) and rapid administration of cryoprecipitate is necessary to maximize the hemostatic effect, especially when the bleeding volume exceeds 10,000 ml.

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Section: Discussionmentioning

confidence: 99%