title: Prediction of Post-Weaning Fibrinogen Status during Cardiopulmonary Bypass: An Observational Study in 110 Patients.
abstract: BACKGROUND
  After cardiac surgery with cardiopulmonary bypass (CPB), acquired coagulopathy often leads to post-CPB bleeding. Though multifactorial in origin, this coagulopathy is often aggravated by deficient fibrinogen levels.
  
  
  OBJECTIVE
  To assess whether laboratory and thrombelastometric testing on CPB can predict plasma fibrinogen immediately after CPB weaning.
  
  
  METHODS
  This prospective study in 110 patients undergoing major cardiovascular surgery at risk of post-CPB bleeding compares fibrinogen level (Clauss method) and function (fibrin-specific thrombelastometry) in order to study the predictability of their course early after termination of CPB. Linear regression analysis and receiver operating characteristics were used to determine correlations and predictive accuracy.
  
  
  RESULTS
  Quantitative estimation of post-CPB Clauss fibrinogen from on-CPB fibrinogen was feasible with small bias (+0.19 g/l), but with poor precision and a percentage of error >30%. A clinically useful alternative approach was developed by using on-CPB A10 to predict a Clauss fibrinogen range of interest instead of a discrete level. An on-CPB A10 ≤10 mm identified patients with a post-CPB Clauss fibrinogen of ≤1.5 g/l with a sensitivity of 0.99 and a positive predictive value of 0.60; it also identified those without a post-CPB Clauss fibrinogen <2.0 g/l with a specificity of 0.83.
  
  
  CONCLUSIONS
  When measured on CPB prior to weaning, a FIBTEM A10 ≤10 mm is an early alert for post-CPB fibrinogen levels below or within the substitution range (1.5-2.0 g/l) recommended in case of post-CPB coagulopathic bleeding. This helps to minimize the delay to data-based hemostatic management after weaning from CPB.
authors.affiliation: Department of Anesthesiology and Pain Therapy, University Hospital Bern, Bern, Switzerland.
authors.forename: Gabor
authors.initials: G
authors.lastname: Erdoes
authors.affiliation: Department of Anesthesiology and Pain Therapy, University Hospital Bern, Bern, Switzerland.
authors.forename: Germaine
authors.initials: G
authors.lastname: Gerster
authors.affiliation: Clinica Luganese Moncucco, Lugano, Switzerland.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colucci
authors.affiliation: Department of Anesthesiology and Pain Therapy, University Hospital Bern, Bern, Switzerland.
authors.forename: Heiko
authors.initials: H
authors.lastname: Kaiser
authors.affiliation: Hématologie non-maligne et Hémostase, Service et Laboratoire central d`Hématologie, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Alberio
authors.affiliation: Department of Anesthesiology and Pain Therapy, University Hospital Bern, Bern, Switzerland.
authors.forename: Balthasar
authors.initials: B
authors.lastname: Eberle
mesh_terms: D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D003710:Demography; D004322:Drainage; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013916:Thrombelastography
chemical_list: D005343:Fibrinolytic Agents; D006454:Hemoglobins; D005340:Fibrinogen