Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Faraoni, David; Willems, Ariane; Savan, Veaceslav; Demanet, Hélène; Villé, A. De; Linden, Philippe Van der

doi:10.1097/eja.0000000000000043

Cited by 73 publications

(72 citation statements)

References 36 publications

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“…50 In paediatric cardiac surgery, post-CPB plasma fibrinogen concentration appears to influence blood loss, with a fibrinogen concentration of at least 1.5 g l À1 or an MCF of at least 3 mm accurately predicting excessive blood loss. 51 Prediction of postoperative bleeding volume using haemostatic assessment, including VHAs, is not convincing. 52,53 However, haemostatic deficiencies are not the sole cause of postoperative bleeding and attempts to predict bleeding are often thwarted by the presence of more obvious surgical causes.…”

Section: Fibrinogen Concentrationmentioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

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693

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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Section: Fibrinogen Concentrationmentioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

Self Cite

693

316

View full text Add to dashboard Cite

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“…In a patient with significant bleeding following cardiac surgery, FFP may be of benefit when the PT is greater than 1·5 times normal. A number of recent studies have correlated fibrinogen levels with blood loss following adult (Kindo et al , ) and paediatric cardiac surgery (Moganasundram et al , ; Faraoni et al , ). A fibrinogen level of 1·5 g/l is commonly used as the transfusion threshold for cryoprecipitate in line with major haemorrhage guidelines (BCSH, ).…”

Section: Cardiac Surgerymentioning

confidence: 99%

Guidelines on transfusion for fetuses, neonates and older children

et al. 2016

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“…This is mainly due to several coagulation defects, namely thrombocytopenia, factor deficiencies, and fibrinolysis as seen in these patients (15)(16)(17)(18). This is mainly due to several coagulation defects, namely thrombocytopenia, factor deficiencies, and fibrinolysis as seen in these patients (15)(16)(17)(18).…”

Section: Discussionmentioning

confidence: 96%

The Coagulative Profile of Cyanotic Children Undergoing Cardiac Surgery: The Role of Whole Blood Preoperative Thromboelastometry on Postoperative Transfusion Requirement

et al. 2015

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The objective of this study is to evaluate the preoperative coagulation pattern and its association to postoperative blood products transfusion in children with congenital heart disease (CHD), focusing on cyanotic patients (oxygen saturation, SATO 2 < 85%). From January to August 2014, preoperative standard coagulation tests and rotational thromboelastometry assays were performed on 81 pediatric patients (<16 years old) who underwent surgery for CHD with the aid of cardiopulmonary bypass. Sixty patients (74%) were acyanotic and 21 (26%) cyanotic. Mean age at time of surgery was 7.9 months (interquartile range 2.9-43.6 months). Cyanotic patients had a significantly higher hematocrit (P < 0.001), a reduced prothrombin activity (PT) (P = 0.01) level, and a lower platelet count (P = 0.02) than acyanotic patients. An inverse linear association was found between patient's SATO2 and clot formation time (CFT) (INTEM, P = 0.001, and EXTEM, P < 0.0001). A direct linear association was found between patient's SATO2 and maximum clot firmness (MCF) (INTEM, P = 0.04, and EXTEM, P = 0.05). Preoperative cyanosis was also associated with a lower median MCF in FIBTEM (P = 0.02). Cyanotic patients required more frequent postoperative transfusions of fibrinogen (7/21 patients, 33% vs. 4/60 patients, 6.7%, P = 0.01) and fresh frozen plasma (14/21, 67% vs. 25/60, 42%, P = 0.08). Patients with a lower presurgery PT and platelet count subsequently required more fibrinogen transfusion P = 0.02 and P = 0.003, respectively); the same goes for patients with a longer CFT (INTEM, P = 0.01 and EXTEM, P = 0.03) and a reduced MCF (INTEM, P = 0.02 and FIBTEM, P = 0.01) as well. Cyanotic patients showed significant preoperative coagulation anomalies and required a higher postoperative fibrinogen supplementation. The preoperative MCF FIBTEM has become an important factor in our postoperative thromboelastometry-guided transfusion protocols.

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Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Cited by 73 publications

References 36 publications

Management of severe perioperative bleeding

Management of severe perioperative bleeding

Guidelines on transfusion for fetuses, neonates and older children

The Coagulative Profile of Cyanotic Children Undergoing Cardiac Surgery: The Role of Whole Blood Preoperative Thromboelastometry on Postoperative Transfusion Requirement

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