Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study.
BACKGROUND
Early identification of patients with increased risk of excessive bleeding and transfusion after cardiac surgery offers the possibility to initiate countermeasures. Fibrinogen is a key protein in the coagulation cascade and thus a potential biomarker for bleeding. We investigated the relationship between preoperative fibrinogen plasma concentration and postoperative bleeding and transfusion after coronary artery bypass grafting (CABG).


METHODS
A total of 170 patients (mean age, 67 +/- 9 years; 75% men) undergoing isolated CABG were included in a prospective observational study. Patient variables (age, sex, operation time, anticoagulation therapy), preoperative laboratory variables (platelet [PLT] count, activated partial thromboplastin time, prothrombin time, and fibrinogen), postoperative bleeding volume, and transfusions during hospital stay were registered. Independent predictors of bleeding volume and transfusion were identified with multiple regression models.


RESULTS
Postoperative bleeding volume correlated univariately with preoperative fibrinogen concentration (r = -0.53, p < 0.001) and PLT count (r = -0.26, p = 0.001) but only preoperative fibrinogen concentration was an independent predictor of postoperative bleeding volume. Twenty-nine of the 170 patients (17%) received transfusions with blood products. Independent predictors of transfusion were preoperative fibrinogen concentration (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.7 per 1-unit decrease; p = 0.027), female sex (OR, 5.0; 95% CI, 1.8-14.7; p = 0.002), and aortic cross-clamp time (OR, 1.03; 95% CI, 1.01-1.06 per minute; p = 0.013).


CONCLUSIONS
The results indicate that preoperative fibrinogen concentration (even within the normal range) is a limiting factor for postoperative hemostasis. Preoperative measurement of fibrinogen concentration provides information about bleeding volume and transfusion requirements after CABG.
Karlsson
Martin
M
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ternström
Lisa
L
Hyllner
Monica
M
Baghaei
Fariba
F
Nilsson
Staffan
S
Jeppsson
Anders
A
D000368:Aged; D001803:Blood Transfusion; D001026:Coronary Artery Bypass; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000453:epidemiology* / Q000628:therapy; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011517:Prothrombin Time; D012044:Regression Analysis; D012307:Risk Factors
D006454:Hemoglobins; D005340:Fibrinogen