title: Pre-operative fibrinogen supplementation in cardiac surgery patients: an evaluation of different trigger values.
abstract: BACKGROUND
  Pre-operative fibrinogen levels are negatively associated with postoperative bleeding in cardiac surgery patients. The guidelines of the European Society of Anaesthesiology consider the possibility of a prophylactic pre-operative supplementation in patients with fibrinogen levels<`3.8 g/l. The present study is a reanalysis of published data aimed to define the diagnostic accuracy of different values of pre-operative fibrinogen levels in predicting severe post-operative bleeding.
  
  
  METHODS
  Data were retrieved for 2154 patients in four different studies. Severe bleeding (SB) was defined as a post-operative chest drain output>1 l/12 h. Diagnostic accuracy for prediction of SB was tested at three cutoff values of pre-operative fibrinogen (2.5 g/l, 3.0 g/l, and 3.8 g/l).
  
  
  RESULTS
  At all the three cutoff values, pre-operative fibrinogen levels had an excellent negative predictive value, ranging from 86% to 100%. Conversely, the positive predictive value was poor at all the cutoff levels: 12% (3.8 g/l), 14% (3.0 g/l), and 19% (2.5 g/l). Overall, the accuracy of pre-operative fibrinogen levels for the prediction of SB was poor. A strategy based on pre-operative fibrinogen supplementation would lead to inappropriate treatment in > 80% of the treated patients. Overall, a trigger value of 3.8 g/l would result in an inappropriate treatment in 52% of the patients, of 3.0 g/l in 20% of the patients, and of 2.5 g/l in 4% of the patients.
  
  
  CONCLUSIONS
  Correction of pre-operative fibrinogen levels below 3.8 g/l would lead to an excessive rate of inappropriate interventions. Values below 2.5 g/l could be considered.
authors.affiliation: Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese (Milan), Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ranucci
authors.forename: A
authors.initials: A
authors.lastname: Jeppsson
authors.forename: E
authors.initials: E
authors.lastname: Baryshnikova
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D005189:False Positive Reactions; D005340:Fibrinogen / Q000032:analysis* / Q000627:therapeutic use*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012016:Reference Values; D016896:Treatment Outcome
chemical_list: D005340:Fibrinogen