Recovery of fibrinogen after administration of fibrinogen concentrate to patients with severe bleeding after cardiopulmonary bypass surgery

Abstract

BackgroundNormalization of plasma fibrinogen levels may be associated with satisfactory haemostasis and reduced bleeding. The aim of this retrospective study was to assess fibrinogen recovery parameters after administration of fibrinogen concentrate (Haemocomplettan® P) to patients with diffuse bleeding in cardiovascular surgery. Data on transfusion and patient outcomes were also collected.MethodsPatient characteristic and clinical data were obtained from patient records. Results of the thromboelastometry (FIBTEM®) and of the standard coagulation tests, including plasma fibrinogen level, measured before surgery, before and after haemostatic therapy, and on the following day, were retrieved from laboratory records.ResultsThirty-nine patients receiving fibrinogen concentrate for diffuse bleeding requiring haemostatic therapy after cardiopulmonary bypass were identified. The mean fibrinogen concentrate dose administered was 6.5 g. The mean fibrinogen level increased from 1.9 to 3.6 g litre−1 (mean increment of 0.28 g litre−1 per gram of concentrate administered); maximum clot firmness increased from 10 to 21 mm. The mean fibrinogen increase was 2.29 (sd 0.7) mg dl−1 per mg kg−1 bodyweight of concentrate administered. Thirty-five patients received no transfusion of fresh-frozen plasma (FFP) or platelet concentrate after receiving fibrinogen concentrate; the remaining four patients received platelet concentrate intraoperatively. Eleven patients received platelets, FFP, or both during the first postoperative day. No venous thromboses, arterial ischaemic events, or deaths were registered during hospitalization.ConclusionsIn this retrospective study, fibrinogen concentrate was effective in increasing plasma fibrinogen level, and contributed to the correction of bleeding after cardiovascular surgery.

Perioperative Administration of Fibrinogen is Associated with Increased Risk of Postoperative Thromboembolic Complications after Cardiac Surgery

“…Solomon et al [28] recently published a retrospective study including 39 elective cardiac surgery patients receiving fibrinogen concentrate with the indication of bleeding. All patients receiving additional coagulation factor concentrates were excluded as well as all patients without measured plasma fibrinogen level prior to fibrinogen infusion and after the number of adverse effects was reported and sufficient increase in plasma fibrinogen was seen after administration of an average 6.5 g; this was larger than the standard dose used in our patient group(2-3 g).…”

How I use fibrinogen replacement therapy in acquired bleeding

“…1,34,64 Maximal amplitude, an equivalent parameter to MCF, can be measured using a functional fibrinogen assay on the TEG device. The fibrinogen dose can be calculated as follows:…”

“…1 Other prospective and retrospective cardiac surgical studies, including high-risk ascending aortic replacement surgery, report that fibrinogen repletion with concentrates reduces postoperative bleeding and allogeneic blood product administration. 34,40,64,79,80 Placebo controlled, randomized studies are currently underway to evaluate the role of fibrinogen repletion in major aortic surgery, and the results are eagerly awaited from a recently completed study (http:// clinicaltrials.gov/show/NCT01475669). There is also a need to further evaluate several recent studies demonstrating significant reductions in bleeding and allogeneic transfusion using fibrinogen concentrates.…”

Effects of High Dose Fibrinogen on in vitro Haemodilution with Different Therapeutic Fluids

“…like Haemocomplettan has in studies been proven to reconstitute or improve coagulation markers after its administration, both in vitro and in vivo. [19,20] Fibrinogen has also shown promise in correcting dilutive coagulopathy regardless of the fluid used, which hasn't been seen for all similar therapies, most notably perhaps activated factor VII [13,20].…”

“…Considering that many fibrinogen studies [19,20] have been performed on the ROTEM or TEG with the platelet function incapacitated with cytochalasin (known as fib-tem and modified TEG) this could possibly have contributed to the lack of fibrinogen response in our samples. Still, recent findings suggest a positive fibrinogen response also in platelet function so this cannot fully explain the lack of reaction [25].…”