title: Preoperative supplementation with fibrinogen concentrate in cardiac surgery: A randomized controlled study.
abstract: BACKGROUND
  Bleeding remains a severe complication in cardiac surgery. Several studies have found an association between the preoperative plasma concentration of fibrinogen and postoperative bleeding in cardiac surgery patients. This raises the question of whether preoperative supplementation with fibrinogen concentrate can reduce postoperative blood loss.
  
  
  METHODS
  An investigator-initiated, prospective, randomized double-blind placebo-controlled study, was performed in 48 low-risk, coronary artery bypass grafting patients. Subjects were randomized to infusion of 2 g fibrinogen or placebo immediately before surgery, after induction of anaesthesia. The primary endpoint was blood loss during the first 12 h postoperatively. Secondary endpoints included the proportion of transfused subjects, the number of transfused allogeneic blood products (red blood cells, plasma and platelets), and haemoglobin concentration after surgery. Student's t-test and Mann-Whitney U-test was used to compare continuous data and χ(2)-test to compare categorical data between groups.
  
  
  RESULTS
  Median postoperative bleeding was not significantly different between the fibrinogen and placebo groups [650 (25/75th percentile 500‒835) ml compared with 730 (543‒980) ml, P=0.29]. The proportion of transfused subjects (33 vs 29%, P=0.76), number of perioperative transfusions of allogeneic blood products (0 (0-2 vs 0 (0-3), P=0.76) and haemoglobin concentration 24 h after surgery (107 (sd 11) vs 100 (12) g L-1, P=0.07) were not significantly different between the fibrinogen and placebo group, respectively.
  
  
  CONCLUSIONS
  Preoperative supplementation with 2 g fibrinogen concentrate did not significantly influence postoperative bleeding, in coronary artery bypass grafting patients without documented hypofibrinogenaemia.
  
  
  BACKGROUND
  NCT 00968045.
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden anders.jeppsson@vgregion.se.
authors.forename: A
authors.initials: A
authors.lastname: Jeppsson
authors.affiliation: Department of Anaesthesia and Intensive Care, Eastern Hospital, Gothenburg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Waldén
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Roman-Emanuel
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Thimour-Bergström
authors.affiliation: Department of Medicine, Skaraborg Hospital, Lidköping, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Karlsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D003029:Coagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005340:Fibrinogen / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D003029:Coagulants; D005340:Fibrinogen
keywords: cardiac surgery; fibrinogen; haemorrhage