Effects of the Preoperative Administration of a Fibrinogen Concentrate on Bleeding and Transfusion Requirements in Cardiac Surgery

Abstract

Background: Contact of blood with the cardiopulmonary bypass (CPB) circuit during cardiac surgery<br />induces acquired multifactorial coagulopathy, which results in an increased risk of bleeding and<br />transfusion requirements. In this study, we investigated the effects of the preoperative<br />administration of fibrinogen concentrates on bleeding and transfusion requirements in cardiac<br />surgery.<br />Methods: Seventy-eight patients scheduled for elective coronary artery bypass graft (CABG) or<br />valvular surgery were included in this clinical trial between March 2017 and November 2017.<br />The patients were randomly assigned to fibrinogen and control groups. In the fibrinogen group,<br />the patients received 2 g of fibrinogen dissolved in 100 mL of normal saline over a 15-minute<br />period 30 minutes after the induction of anesthesia. In the control group, the patients received<br />the same volume of normal saline during the same period of time. The evaluation of the<br />coagulation system was performed via thromboelastometry (Rotem device). Postoperative<br />bleeding was recorded as the overall mediastinal drainage or the other drainage at the surgical<br />site during a 24-hour period after surgery. The volumes of transfused packed red blood cells,<br />fresh frozen plasma (FFP), and platelet concentrates were recorded.<br />Results: The value of Fibtem-MCF did not show any significant difference between the groups (12.4±4<br />vs 11.7±4 0.46; P=0.46). The mean volume of bleeding was significantly lower in the<br />fibrinogen group than in the control group (168±12 vs 344±37; P=0.001). The mean volume of<br />the platelet concentrate used was significantly lower in the fibrinogen group than in the control<br />group (P<0.05). However, there was no significant difference in terms of RBCs and FFP<br />consumption between the groups.<br />Conclusions: It appears that although preoperative supplementation with fibrinogen has no effect on<br />transfusion with RBCs and FFP, it results in a reduction in postoperative blood loss and platelet<br />concentrate requirement during cardiac surgery.