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

C Solomon, U Pichlmaier, H Schoechl, C Hagl, K Raymondos, D Scheinichen, W Koppert, N Rahe-Meyer, C Solomon, U Pichlmaier, H Schoechl, C Hagl, K Raymondos, D Scheinichen, W Koppert, N Rahe-Meyer

Abstract

Background: Normalization 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.

Methods: Patient 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. Results Thirty-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.

Conclusions: In this retrospective study, fibrinogen concentrate was effective in increasing plasma fibrinogen level, and contributed to the correction of bleeding after cardiovascular surgery.

Figures

Fig 1
Fig 1
Box-and-whisker plots of plasma fibrinogen levels measured using the Clauss method at baseline, end of CPB, after administration of fibrinogen concentrate, and during the first postoperative day. The boxes represent the lower (25th) and upper (75th) quartiles, the horizontal line represents the mean, the whiskers extend to 95% confidence intervals for the mean, and the circle represents an outlier. Grey shading indicates the normal range of plasma fibrinogen levels.

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