Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial.
Niels Rahe-Meyer,Cristina Solomon,Alexander A. Hanke,Dirk S. Schmidt,Dietrich Knoerzer,Gerald Hochleitner,Benny Sørensen,Christian Hagl,Maximilian Pichlmaier +8 more
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Hemostatic therapy with fibrinogen concentrate in patients undergoing aortic surgery significantly reduced the transfusion of allogeneic blood products.Abstract:
BACKGROUND Fibrinogen is suggested to play an important role in managing major bleeding. However, clinical evidence regarding the effect of fibrinogen concentrate (derived from human plasma) on transfusion is limited. The authors assessed whether fibrinogen concentrate can reduce blood transfusion when given as intraoperative, targeted, first-line hemostatic therapy in bleeding patients undergoing aortic replacement surgery. METHODS In this single-center, prospective, placebo-controlled, double-blind study, patients aged 18 yr or older undergoing elective thoracic or thoracoabdominal aortic replacement surgery involving cardiopulmonary bypass were randomized to fibrinogen concentrate or placebo, administered intraoperatively. Study medication was given if patients had clinically relevant coagulopathic bleeding immediately after removal from cardiopulmonary bypass and completion of surgical hemostasis. Dosing was individualized using the fibrin-based thromboelastometry test. If bleeding continued, a standardized transfusion protocol was followed. RESULTS Twenty-nine patients in the fibrinogen concentrate group and 32 patients in the placebo group were eligible for the efficacy analysis. During the first 24 h after the administration of study medication, patients in the fibrinogen concentrate group received fewer allogeneic blood components than did patients in the placebo group (median, 2 vs. 13 U; P < 0.001; primary endpoint). Total avoidance of transfusion was achieved in 13 (45%) of 29 patients in the fibrinogen concentrate group, whereas 32 (100%) of 32 patients in the placebo group received transfusion (P < 0.001). There was no observed safety concern with using fibrinogen concentrate during aortic surgery. CONCLUSIONS Hemostatic therapy with fibrinogen concentrate in patients undergoing aortic surgery significantly reduced the transfusion of allogeneic blood products. Larger multicenter studies are necessary to confirm the role of fibrinogen concentrate in the management of perioperative bleeding in patients with life-threatening coagulopathy.read more
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Journal ArticleDOI
Fibrinogen levels measured by the dry hematology method are lower than those measured by the Clauss method under a high concentration of heparin.
Shogo Suzuki,Takahiro Tamura,Kazuko Hasegawa,Sho Maeda,Reona Mori,Motoshi Kainuma,Yushi U. Adachi,Kimitoshi Nishiwaki +7 more
TL;DR: The DH method may be useful for decision-making with regard to perioperative coagulation factor replacement, and in patients on high-dose heparin, the mean fibrinogen level measured by the DH method was significantly lower than that measured bythe conventional Clauss method.
Clinical Aspects of Bleeding and Transfusion in Cardiac Surgery
TL;DR: The relationship between preoperative levels of fibrinogen and other coagulation factors, and their relationship to postoperative bleeding and blood transfusion, and the effects of a structured blood conservation programme were examined to reduce the administration of blood transfusions in cardiac surgical patients.
Book ChapterDOI
Rational and Timely Use of Coagulation Factor Concentrates in Massive Bleeding Without Point-of-Care Coagulation Monitoring
TL;DR: This chapter describes the approach to emergency hemostatic management in severely bleeding patients when diagnostic information from point-of-care coagulation monitoring (thromboelastometry [ROTEM], thrombelastography] is unavailable and outlines a stepwise approach that could be considered for this purpose.
Journal ArticleDOI
A randomised controlled trial of fibrinogen concentrate during scoliosis surgery
TL;DR: Fibrinogen reduced peri‐operative blood loss by a median (95%CI) volume of 155 (5–320) ml, from a Median (IQR [range]) of 1035 (818–1420 [400–3030]) ml to 885 (755–1155 [270–2645]) ml, p = 0.04.
References
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Journal ArticleDOI
Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery
Gavin J. Murphy,Barnaby C Reeves,Chris A Rogers,Syed Ibrahim Rizvi,Lucy Culliford,Gianni D Angelini +5 more
TL;DR: Red blood cell transfusion in patients having cardiac surgery is strongly associated with both infection and ischemic postoperative morbidity, hospital stay, increased early and late mortality, and hospital costs.
Journal ArticleDOI
Practice guidelines for perioperative blood transfusion and adjuvant therapies: An updated report by the American Society of Anesthesiologists Task Force on perioperative blood transfusion and adjuvant therapies
Gregory A. Nuttall,Brian C. Brost,Richard T. Connis,James S. Gessner,Chantal R. Harrison,Ronald D. Miller,David G. Nickinovich,Nancy A. Nussmeier,Andrew D. Rosenberg,Richard Spence +9 more
Journal ArticleDOI
Management of bleeding following major trauma: an updated European guideline
Rolf Rossaint,Bertil Bouillon,Vladimir Cerny,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Beverley J. Hunt,Radko Komadina,Giuseppe Nardi,Edmund Neugebauer,Yves Ozier,Louis Riddez,Arthur Schultz,Philip F. Stahel,Jean Louis Vincent,Donat R. Spahn +15 more
TL;DR: This document presents an updated version of the guideline for the management of bleeding following severe injury, which provides an evidence-based multidisciplinary approach to themanagement of critically injured bleeding trauma patients.
Journal ArticleDOI
Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography.
L. Rugeri,A. Levrat,Jean-Stéphane David,E. Delecroix,Bernard Floccard,A. Gros,Bernard Allaouchiche,Claude Negrier +7 more
TL;DR: ROTEM is a point‐of‐care device that rapidly detects systemic changes of in vivo coagulation in trauma patients, and it might be a helpful device in guiding transfusion.
Journal ArticleDOI
Prevention and treatment of major blood loss.
TL;DR: The benefits of hemostatic drugs are reviewed and the associated risk of adverse events, particularly thrombotic complications, are considered.
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