title: Fibrinogen concentrate as first-line therapy in aortic surgery reduces transfusion requirements in patients with platelet counts over or under 100×10(9)/L.
abstract: BACKGROUND
  Administration of fibrinogen concentrate, targeting improved maximum clot firmness (MCF) of the thromboelastometric fibrin-based clot quality test (FIBTEM) is effective as first-line haemostatic therapy in aortic surgery. We performed a post-hoc analysis of data from a randomised, placebo-controlled trial of fibrinogen concentrate, to investigate whether fibrinogen concentrate reduced transfusion requirements for patients with platelet counts over or under 100×10(9)/L.
  
  
  METHODS
  Aortic surgery patients with coagulopathic bleeding after cardiopulmonary bypass were randomised to receive either fibrinogen concentrate (n=29) or placebo (n=32). Platelet count was measured upon removal of the aortic clamp, and coagulation and haematology parameters were measured peri-operatively. Transfusion of allogeneic blood components was recorded and compared between groups.
  
  
  RESULTS
  After cardiopulmonary bypass, haemostatic and coagulation parameters worsened in all groups; plasma fibrinogen level (determined by the Clauss method) decreased by 43-58%, platelet count by 53-64%, FIBTEM maximum clot firmness (MCF) by 38-49%, FIBTEM maximum clot elasticity (MCE) by 43-54%, extrinsically activated test (EXTEM) MCF by 11-22%, EXTEM MCE by 25-41% and the platelet component of the clot by 23-39%. Treatment with fibrinogen concentrate (mean dose 7-9 g in the 4 groups) significantly reduced post-operative allogeneic blood component transfusion requirements when compared to placebo both for patients with a platelet count≥100×10(9)/L and for patients with a platelet count<100×10(9)/L.
  
  
  CONCLUSIONS
  FIBTEM-guided administration of fibrinogen concentrate reduced transfusion requirements when used as a first-line haemostatic therapy during aortic surgery in patients with platelet counts over or under 100×10(9)/L.
authors.affiliation: Department of Anaesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University, Salzburg, Austria.|CSL Behring, Marburg, Germany.
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.affiliation: Clinic for Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.|Clinic for Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: Rahe-Meyer
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017713:Platelet Transfusion; D011446:Prospective Studies
chemical_list: D005340:Fibrinogen