title: Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.
abstract: We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements.
authors.affiliation: Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sabate
authors.affiliation: Department of Anesthesiology, Hospital Universitario de Cruces, Bilbao, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Gutierrez
authors.affiliation: Department of Anesthesiology, Hospital Clinic Universitari, University of Barcelona Health Campus, Idibaps, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Beltran
authors.affiliation: Department of Anesthesiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Mellado
authors.affiliation: Department of Anesthesiology, Hospital Clinic Universitari, University of Barcelona Health Campus, Idibaps, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Blasi
authors.affiliation: Department of Anesthesiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Acosta
authors.affiliation: Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Costa
authors.affiliation: Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Reyes
authors.affiliation: Medical Statistics Core Facility, IDIBAPS, Hospital Clinic Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004311:Double-Blind Method; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage / Q000494:pharmacology*; D005500:Follow-Up Studies; D006490:Hemostatics; D006801:Humans; D008107:Liver Diseases / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D006490:Hemostatics; D005340:Fibrinogen
keywords: anesthesia/pain management; clinical research/practice; coagulation and hemostasis; transfusion