title: Fibrinogen recovery and changes in fibrin-based clot firmness after cryoprecipitate administration in patients undergoing aortic surgery involving deep hypothermic circulatory arrest.
abstract: BACKGROUND
  Cryoprecipitate may be used to treat bleeding in cardiac surgery. Its effects on plasma fibrinogen and fibrin clotting in this setting are poorly defined.
  
  
  METHODS
  Patients undergoing on-pump aortic surgery with deep hypothermic circulatory arrest (DHCA) were recruited prospectively. After protamine reversal, cryoprecipitate was administered to patients with bleeding, and fibrin deficit was indicated by thromboelastometry (ROTEM)-based FIBTEM test. Coagulation was assessed using ROTEM-based tests and standard laboratory tests before and after cryoprecipitate.
  
  
  RESULTS
  Thirteen patients were included. Cryoprecipitate significantly elevated EXTEM A10 from (mean ± standard deviation) 29.4 ± 5.8 to 34.8 ± 5.9 mm (p = 0.01), FIBTEM A10 from 3.5 ± 0.9 to 5.8 ± 1.7 mm (p = 0.04), and plasma fibrinogen concentration from 154.2 ± 25.6 to 193.4 ± 30.5 mg/dL (p = 0.01). EXTEM clot elasticity at 10 minutes (CE10) increased from 42.5 ± 12.0 to 54.7 ± 14.9 mm after cryoprecipitate (30.0% increase). FIBTEM CE10 increased from 3.7 ± 0.9 to 6.2 ± 2.0 mm (53.0% increase). A fibrinogen dose of 13.2 ± 5.2 mg/kg was required to increase FIBTEM A10 by 1 mm. In vivo recovery of fibrinogen was 61.6 ± 31.2%.
  
  
  CONCLUSIONS
  Cryoprecipitate increased plasma fibrinogen levels and fibrin-based clotting in bleeding patients undergoing aortic surgery with DHCA. In vivo recovery of fibrinogen was considerably below 100% and fibrinogen content varied between cryoprecipitate units. Trials are needed to assess whether cryoprecipitate impacts clinical outcomes and to evaluate its safety.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung City, Gyunggi do, Republic of Korea; Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Sangmin M
authors.initials: SM
authors.lastname: Lee
authors.forename: Chung Su
authors.initials: CS
authors.lastname: Kim
authors.forename: Hyun Sung
authors.initials: HS
authors.lastname: Cho
authors.forename: Jong-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Cheol Hee
authors.initials: CH
authors.lastname: Lee
authors.forename: Eunhee
authors.initials: E
authors.lastname: Kim
authors.forename: Kiick
authors.initials: K
authors.lastname: Sung
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.forename: Jingu
authors.initials: J
authors.lastname: Kang
authors.forename: Young Ri
authors.initials: YR
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001777:Blood Coagulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005169:Factor VIII / Q000008:administration & dosage*; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013916:Thrombelastography
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen