title: Perioperative administration of fibrinogen does not increase adverse cardiac and thromboembolic events after cardiac surgery.
abstract: BACKGROUND
  Although infusion of fibrinogen concentrate is increasingly used in bleeding patients after cardiac surgery, safety data are scarce. We aimed to evaluate the effect of perioperative administration of fibrinogen concentrate on postoperative morbidity and mortality in patients undergoing cardiac surgery.
  
  
  METHODS
  During a 2 yr study period, 991 patients underwent cardiac surgery at a single university centre and were eligible for propensity score (PS) matching. We matched 190 patients with perioperative infusion of fibrinogen concentrate (median dose 2 g) with 190 controls without fibrinogen administration. After PS matching, crude outcome was analysed. Further, a multivariate logistic regression including additional risk factors for adverse outcome was performed. The primary endpoint was a composite of mortality and the occurrence of major cardiac and thromboembolic events within 1 yr. Secondary outcomes included mortality after 30 days and 1 yr and the composite of mortality and adverse events after 30 days.
  
  
  RESULTS
  The administration of fibrinogen concentrate was not associated with an increased risk for mortality and thromboembolic or cardiac events within 1 yr after cardiac surgery [unadjusted hazard ratio (HR) 0.91; 95% confidence interval (CI) 0.55-1.49; P=0.697]. When using multivariate logistic regression model, the HR for adverse outcome in patients with administration of fibrinogen concentrate was 0.57 (95% CI 0.25-1.17; P=0.101). Similarly, the administration of fibrinogen concentrate did not adversely affect the secondary outcomes when applying unadjusted and multivariate regression analyses.
  
  
  CONCLUSIONS
  Our study strongly suggests that the administration of fibrinogen concentrates at low dose is not associated with thromboembolic complications or adverse outcomes after cardiac surgery.
authors.affiliation: Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy and.
authors.forename: J
authors.initials: J
authors.lastname: Fassl
authors.affiliation: Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy and.
authors.forename: G
authors.initials: G
authors.lastname: Lurati Buse
authors.affiliation: Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy and Institute of Anesthesiology, Cantonal Hospital, St Gallen, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Filipovic
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, CH-4031 Basel, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Reuthebuch
authors.affiliation: Institute of Anesthesiology, Spitalzentrum Biel, Biel-Bienne, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Hampl
authors.affiliation: Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy and.
authors.forename: M D
authors.initials: MD
authors.lastname: Seeberger
authors.affiliation: Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy and dabolliger@uhbs.ch.
authors.forename: D
authors.initials: D
authors.lastname: Bolliger
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000009:adverse effects* / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology; D006490:Hemostatics / Q000009:adverse effects* / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013923:Thromboembolism / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology
chemical_list: D006490:Hemostatics; D005340:Fibrinogen
keywords: cardiac surgery; fibrinogen; thromboembolism; treatment outcome