title: Use of human fibrinogen concentrate during proximal aortic reconstruction with deep hypothermic circulatory arrest.
abstract: OBJECTIVE
  Human fibrinogen concentrate (HFC) is approved by the Food and Drug Administration for use at 70 mg/kg to treat congenital afibrinogenemia. We sought to determine whether this dose of HFC increases fibrinogen levels in the setting of high-risk bleeding associated with aortic reconstruction and deep hypothermic circulatory arrest (DHCA).
  
  
  METHODS
  This was a prospective, pilot, off-label study in which 22 patients undergoing elective proximal aortic reconstruction with DHCA were administered 70 mg/kg HFC upon separation from cardiopulmonary bypass (CPB). Fibrinogen levels were measured at baseline, just before, and 10 minutes after HFC administration, on skin closure, and the day after surgery. The primary study outcome was the difference in fibrinogen level immediately after separation from CPB, when HFC was administered, and the fibrinogen level 10 minutes following HFC administration. Additionally, postoperative thromboembolic events were assessed as a safety analysis.
  
  
  RESULTS
  The mean baseline fibrinogen level was 317 ± 49 mg/dL and fell to 235 ± 39 mg/dL just before separation from CPB. After HFC administration, the fibrinogen level rose to 331 ± 41 mg/dL (P < .001) and averaged 372 ± 45 mg/dL the next day. No postoperative thromboembolic complications occurred.
  
  
  CONCLUSIONS
  Administration of 70 mg/kg HFC upon separation from CPB raises fibrinogen levels by approximately 100 mg/dL without an apparent increase in thrombotic complications during proximal aortic reconstruction with DHCA. Further prospective study in a larger cohort of patients will be needed to definitively determine the safety and evaluate the efficacy of HFC as a hemostatic adjunct during these procedures.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hanna
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Keenan
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Hanghang
authors.initials: H
authors.lastname: Wang
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Andersen
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gaca
authors.affiliation: Division of Cardiac Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Lombard
authors.affiliation: Division of Cardiac Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: ian.welsby@dm.duke.edu.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Welsby
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
mesh_terms: D000328:Adult; D001011:Aorta / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects; D017558:Elective Surgical Procedures; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage* / Q000009:adverse effects; D006490:Hemostatics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010865:Pilot Projects; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D005340:Fibrinogen
keywords: anesthesia; aortic reconstruction; bleeding; blood coagulation; blood transfusion; circulatory arrest; coagulopathy; deep hypothermia; fibrinogen