title: Fibrinogen concentration significantly decreases after on-pump versus off-pump coronary artery bypass surgery: a systematic point-of-care ROTEM analysis.
abstract: OBJECTIVE
  Studies have emphasized the importance of normal fibrinogen concentrations in surgical patients. The primary hypothesis of this study was that fibrinogen levels significantly decrease in on-pump coronary artery bypass graft (CABG) surgery versus off-pump coronary artery bypass graft (OPCAB) surgery. The second objective was to show that ROTEM (TEM International, GmbH, Munich, Germany) rapidly detects these abnormalities compared with standard tests.
  
  
  METHODS
  A prospective, nonrandomized study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Forty-two and 62 patients in the CABG and OPCAB groups, respectively, undergoing first-time bypass surgery were included.
  
  
  METHODS
  CABG versus OPCAB surgery.
  
  
  RESULTS
  Routine coagulation tests and ROTEM values were measured before anesthesia (T0), after the first dose of heparin (T1), after protamine (T2), upon intensive care unit arrival (T3), and 4 hours postoperatively (T4). The outcome measures were followed until 4 hours postoperatively. Fibrinogen concentrations were significantly lower in the CABG versus the OPCAB group at T2 (170 ± 44 v 243 ± 73 mg/dL, p < 0.001) and T3 (179 ± 42 v 232 ± 68 mg/dL, p < 0.001). This was confirmed by significantly lower FIBTEM maximal clot firmness values at T2 (9 ± 4 v 14 ± 5 mm, p < 0.001) and T3 (9 ± 4 v 13 ± 6 mm, p < 0.001). In the CABG group, patients received significantly more transfusions of all blood products except fresh frozen plasma.
  
  
  CONCLUSIONS
  Fibrinogen concentration significantly decreases after cardiopulmonary bypass. ROTEM helps in its fast detection.
authors.affiliation: Department of Anesthesiology, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium. mona.momeni@uclouvain.be
authors.forename: Mona
authors.initials: M
authors.lastname: Momeni
authors.forename: Cécile
authors.initials: C
authors.lastname: Carlier
authors.forename: Philippe
authors.initials: P
authors.lastname: Baele
authors.forename: Christine
authors.initials: C
authors.lastname: Watremez
authors.forename: Michel
authors.initials: M
authors.lastname: Van Dyck
authors.forename: Amine
authors.initials: A
authors.lastname: Matta
authors.forename: David
authors.initials: D
authors.lastname: Kahn
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Rennotte
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Laurent
authors.initials: L
authors.lastname: de Kerchove
authors.forename: Luc-Marie
authors.initials: LM
authors.lastname: Jacquet
authors.forename: Dominique
authors.initials: D
authors.lastname: Thiry
authors.forename: André
authors.initials: A
authors.lastname: Grégoire
authors.forename: Stéphane
authors.initials: S
authors.lastname: Eeckhoudt
authors.forename: Cédric
authors.initials: C
authors.lastname: Hermans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D005340:Fibrinogen