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

• Published in: British journal of anaesthesia : BJA Vol. 116; no. 2; pp. 208 - 214
• Main Authors: Jeppsson, A., Waldén, K., Roman-Emanuel, C., Thimour-Bergström, L., Karlsson, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2016; Oxford University Press
• Subjects: Aged; Aged, 80 and over; Anestesi och intensivvård; Anesthesiology; Anesthesiology and Intensive Care; bypass; cardiac surgery; Cardiac Surgical Procedures; Coagulants - administration & dosage; Coagulants - therapeutic use; controlled-trial; Double-Blind Method; fibrinogen; Fibrinogen - administration & dosage; Fibrinogen - therapeutic use; haemorrhage; Humans; Middle Aged; Postoperative Hemorrhage - prevention & control; Preoperative Care - methods; Prospective Studies; transfusions; Treatment Outcome; fibrinogen; cardiac surgery; haemorrhage
• ISSN: 0007-0912; 1471-6771; 1471-6771
• DOI: 10.1093/bja/aev367

Bleeding remains a severe complication in cardiac surgery. Several studies have found an association between the preoperative plasma concentration of fibrinogen and postoperative bleeding in cardiac surgery patients. This raises the question of whether preoperative supplementation with fibrinogen concentrate can reduce postoperative blood loss. An investigator-initiated, prospective, randomized double-blind placebo-controlled study, was performed in 48 low-risk, coronary artery bypass grafting patients. Subjects were randomized to infusion of 2 g fibrinogen or placebo immediately before surgery, after induction of anaesthesia. The primary endpoint was blood loss during the first 12 h postoperatively. Secondary endpoints included the proportion of transfused subjects, the number of transfused allogeneic blood products (red blood cells, plasma and platelets), and haemoglobin concentration after surgery. Student’s t-test and Mann-Whitney U-test was used to compare continuous data and χ2-test to compare categorical data between groups. Median postoperative bleeding was not significantly different between the fibrinogen and placebo groups [650 (25/75th percentile 500—835) ml compared with 730 (543—980) ml, P+0.29]. The proportion of transfused subjects (33 vs 29%, P+0.76), number of perioperative transfusions of allogeneic blood products (0 (0–2 vs 0 (0–3), P+0.76) and haemoglobin concentration 24 h after surgery (107 (sd 11) vs 100 (12) g L−1, P+0.07) were not significantly different between the fibrinogen and placebo group, respectively. Preoperative supplementation with 2 g fibrinogen concentrate did not significantly influence postoperative bleeding, in coronary artery bypass grafting patients without documented hypofibrinogenaemia. NCT 00968045.