Preoperative supplementation with fibrinogen concentrate in cardiac surgery: A randomized controlled study

Jeppsson, Anders; Waldén, Katarina; Roman-Emanuel, Christine; Thimour-Bergström, Linda; Karlsson, MariAnne

doi:10.1093/bja/aev367

Cited by 52 publications

(40 citation statements)

References 18 publications

(17 reference statements)

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“…Fibrinogen supplementation does not always increase the serum fibrinogen level. In this regard, Jeppsson et al [20] found an even lower postoperative fibrinogen level in their treatment group. Also, 2 g of the concentrate might not be enough to increase the fibrinogen level.…”

Section: Discussionmentioning

confidence: 83%

“…Despite previous experiences in blood loss control with fibrinogen concentrate in various surgical fields , questions about its effectiveness in prostatectomy patients still remain. Hence, this clinical trial investigated the effects and possible adverse effects of fibrinogen concentrate on the amount of bleeding in men undergoing TUR‐P.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, in major trauma patients or those with elective surgeries with risks of excessive bleeding (e.g. cardiac surgery), administering fibrinogen supplementation has demonstrated acceptable results [11][12][13][14][15][16][17][18][19][20]. Its administration is recommended to maintain plasma fibrinogen levels of > 1.5 g L À1 [21].…”

Section: Introductionmentioning

confidence: 99%

“…Despite previous experiences in blood loss control with fibrinogen concentrate in various surgical fields [11][12][13][14][15][16][17][18][19][20], questions about its effectiveness in prostatectomy patients still remain. Hence, this clinical trial investigated the effects and possible adverse effects of fibrinogen concentrate on the amount of bleeding in men undergoing TUR-P. To the authors' knowledge, this is the first study on administering fibrinogen supplementation as a hemostatic strategy in men undergoing TUR-P.…”

Section: Introductionmentioning

confidence: 99%

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The effect of fibrinogen concentrate on perioperative bleeding in transurethral resection of the prostate: a double‐blind placebo‐controlled and randomized study

Soleimani

Masoumi

Nooraei

et al. 2017

Journal of Thrombosis and Haemostasis

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Background Hemorrhage during transurethral resection of the prostate (TUR-P) has always been a concern. Several studies have shown preoperative administration of fibrinogen concentrate to have promising results in reducing hemorrhage in cardiac surgery. Objectives To investigate the hemostatic effect of fibrinogen concentrate administration on reducing the amount of bleeding during TUR-P in patients with benign prostatic hyperplasia. Methods Sixty men with benign prostatic hyperplasia, who were chosen to undergo TUR-P, entered this prospective randomized double-blind placebo-controlled study. The participants were randomly assigned to two groups: treatment (n = 31) and placebo (n = 29). They received an infusion of 2 g of fibrinogen concentrate (treatment group) or normal saline (placebo group) before surgery. Data regarding the amount of bleeding, the operation and complications were recorded and analyzed. Results No difference was observed in bleeding between the fibrinogen and placebo groups during (521 mL versus 557 mL, respectively) and after (291 mL versus 341 mL, respectively) surgery. This lack of difference was also seen in operation time (43 min versus 42 min), irrigating fluid volume used during (17 L versus 19 L) and after (29 L versus 28 L) surgery, and resected adenoma volume (19 g versus 19 g). The mean blood pressure was also similar in both groups as a confounding factor for the amount of bleeding. Conclusion Preoperative administration of fibrinogen concentrate had no significant influence on intraoperative and postoperative bleeding in TUR-P surgery.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of fibrinogen concentrate on perioperative bleeding in transurethral resection of the prostate: a double‐blind placebo‐controlled and randomized study

Soleimani

Masoumi

Nooraei

et al. 2017

Journal of Thrombosis and Haemostasis

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“…Several studies have provided evidence supporting its superiority to conventional treatment using FFP and a recently published trial (FIBRES) demonstrated non‐inferiority of fibrinogen concentrate compared with Cryo usage in severe bleeding . Other studies have shown conflicting results . Results from single‐center studies with different designs (prophylactic approach or bleeding assessment) could not be confirmed by an international multicenter trial (REPLACE) .…”

Section: Introductionmentioning

confidence: 99%

The prophylactic use of fibrinogen concentrate in high‐risk cardiac surgery

Kwapisz

Kent

DiQuinzio

et al. 2020

Acta Anaesthesiol Scand

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Background Perioperative blood loss is a major contributor to morbidity and mortality in cardiac surgery. Plasma fibrinogen levels play an essential role in hemostasis and deplete quickly during hemorrhage. The objective of this study was to determine whether prophylactic fibrinogen concentrate administration lowers overall blood product transfusion requirements in high‐risk cardiac surgery in patients with low fibrinogen plasma levels. Methods The study was performed in a prospective, randomized, and double‐blinded design. The investigation included 62 patients undergoing elective, high‐risk cardiac surgery. After weaning from cardiopulmonary bypass and reversal of heparin patients received either fibrinogen concentrate or placebo. The primary outcome variable was overall blood product usage 24 hours after intervention. Results The fibrinogen group received numerically fewer total units of blood products than the placebo group, but the difference was not statistically or clinically significant (for groups n = 27; n = 29 and 19 vs 37 units, respectively, P = .908). The overall transfusion rate in both groups was significantly lower than the institutional average suggested (fibrinogen group 26%, placebo group 28%). The fibrinogen group showed significantly higher fibrinogen levels (2.38 vs 1.83 g/L (end of surgery), P < .001; 3.33 vs 2.68 g/L (12 hours after intervention), P = .003) and improved viscoelastic coagulation parameters (FIBTEM MCF, 27 vs 23 mm, P = .022). Conclusion This randomized, controlled trial demonstrates that point‐of‐care guided and prophylactic treatment with fibrinogen concentrate does not reduce transfusion of blood products in a setting of unexpectedly low transfusion rate as tested in this cohort, but may improve coagulation parameters in the setting of high‐risk cardiac surgery.

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Pro-coagulant haemostatic factors for the prevention and treatment of bleeding in people without haemophilia

Fabes

Brunskill

Curry

et al. 2018

Cochrane Database of Systematic Reviews

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Preoperative supplementation with fibrinogen concentrate in cardiac surgery: A randomized controlled study

Abstract: NCT 00968045.

Cited by 52 publications

References 18 publications

The effect of fibrinogen concentrate on perioperative bleeding in transurethral resection of the prostate: a double‐blind placebo‐controlled and randomized study

The effect of fibrinogen concentrate on perioperative bleeding in transurethral resection of the prostate: a double‐blind placebo‐controlled and randomized study

The prophylactic use of fibrinogen concentrate in high‐risk cardiac surgery

Pro-coagulant haemostatic factors for the prevention and treatment of bleeding in people without haemophilia

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