Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study.
BACKGROUND
Bleeding diathesis after aortic valve operation and ascending aorta replacement (AV-AA) is managed with fresh-frozen plasma (FFP) and platelet concentrates. The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration.


METHODS
A blood products transfusion algorithm was developed using retrospective data from 42 elective patients (Group A). Two units of platelet concentrate were transfused after cardiopulmonary bypass, followed by 4 u of FFP if bleeding persisted, if platelet count was < or =100 x 10(3) microl(-1) when removing the aortic clamp, and vice versa if platelet count was >100 x 10(3) microl(-1). The trigger for each therapy step was > or =60 g blood absorbed from the mediastinal wound area by dry swabs in 5 min. Assignment to two prospective groups was neither randomized nor blinded; Group B (n=5) was treated according to the algorithm, Group C (n=10) received fibrinogen concentrate (Haemocomplettan P/Riastap, CSL Behring, Marburg, Germany) before the algorithm-based therapy.


RESULTS
A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients. Group C had reduced transfusion [mean 0.7 (range 0-4) u vs 8.5 (5.3) in Group A and 8.2 (2.3) in Group B] and reduced postoperative bleeding [366 (199) ml vs 793 (560) in Group A and 716 (219) in Group B].


CONCLUSIONS
In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV-AA.
Rahe-Meyer
N
N
Department of Anaesthesiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany. rahe-meyer.niels@mh-hannover.de
Pichlmaier
M
M
Haverich
A
A
Solomon
C
C
Winterhalter
M
M
Piepenbrock
S
S
Tanaka
K A
KA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000768:Anesthesia, General / Q000379:methods; D001021:Aortic Valve / Q000601:surgery; D016913:Blood Component Transfusion; D002315:Cardiopulmonary Bypass; D003029:Coagulants / Q000097:blood / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004812:Epidemiologic Methods; D005260:Female; D005340:Fibrinogen / Q000378:metabolism / Q000627:therapeutic use*; D019918:Heart Valve Prosthesis Implantation; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D013916:Thrombelastography
D003029:Coagulants; D005340:Fibrinogen