title: Four-Group Classification Based on Fibrinogen Level and Fibrin Polymerization Associated With Postoperative Bleeding in Cardiac Surgery.
abstract: Fibrinogen and fibrin formation have a key role in perioperative hemostasis. The aim of this study is to examine the association of postoperative hemostasis with a combined evaluation of the fibrinogen level and fibrin polymerization in cardiac surgery. We retrospectively classified 215 consecutive cardiac surgery patients into 4 groups (Fuji-san classification) that were divided by fibrinogen level <150 mg/dL (ie, hypofibrinogenemia) and fibrinogen thromboelastometry value at 10 minutes with rotational thromboelastometry <6 mm (ie, low fibrin polymerization) at the warming of cardiopulmonary bypass. Four groups resulted; group I, the acceptable range (n = 85); group II, only hypofibrinogenemia (<150 mg/dL, ≥6 mm, n = 63); group III, hypofibrinogenemia and low fibrin polymerization (<150 mg/dL, <6 mm, n = 60); and group IV, only low fibrin polymerization (≥150 mg/dL, <6 mm, n = 7). The risk of chest tube drainage volume greater than 500 mL within the first 24 hours after surgery (with group I as the reference) was increased in group II (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.5-7.4; P < .01) and group III (OR, 8.5; 95% CI, 3.5-21.7; P < .01), and the risk greater than 1000 mL (with group I as the reference) was increased in group III (OR, 4.0; 95% CI, 1.1-17.3; P = .03) and group IV (OR, 23.1; 95% CI, 3.2-201.0; P < .01). Intraoperative blood transfusions were decreased by 24.5%, after stratifying the starting amount of fresh frozen plasma by the 4-group classification in the recent consecutive 65 (30.2%) patients (P < .01). The 4-group classification is associated with postoperative bleeding and may improve the quality of perioperative blood transfusion in cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kawashima
authors.affiliation: Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Labour Health and Welfare Organization, Hamamatsu, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Anesthesiology, Iwata City Hospital, Iwata, Japan.
authors.forename: Tsunehisa
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Labour Health and Welfare Organization, Hamamatsu, Japan mkikura@hotmail.com mkikura@aol.com.
authors.forename: Mutsuhito
authors.initials: M
authors.lastname: Kikura
authors.affiliation: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takasumi
authors.initials: T
authors.lastname: Katoh
authors.affiliation: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Shigehito
authors.initials: S
authors.lastname: Sato
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism*; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058105:Polymerization; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*
chemical_list: D005337:Fibrin; D005340:Fibrinogen
keywords: blood coagulation; cardiac surgery; fibrinogen; hemostasis; thromboelastometry