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BJA Advance Access originally published online on May 2, 2009
British Journal of Anaesthesia 2009 102(6):785-792; doi:10.1093/bja/aep089
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© 2009 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study

N. Rahe-Meyer1,*, M. Pichlmaier2, A. Haverich2, C. Solomon1, M. Winterhalter1, S. Piepenbrock1 and K. A. Tanaka3

1 Department of Anaesthesiology
2 Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
3 Department of Anesthesiology, Emory University, School of Medicine, Atlanta, GA, USA

* Corresponding author. E-mail: rahe-meyer.niels{at}mh-hannover.de

Background: Bleeding diathesis after aortic valve operation and ascending aorta replacement (AV–AA) is managed with fresh-frozen plasma (FFP) and platelet concentrates. The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration.

Methods: A blood products transfusion algorithm was developed using retrospective data from 42 elective patients (Group A). Two units of platelet concentrate were transfused after cardiopulmonary bypass, followed by 4 u of FFP if bleeding persisted, if platelet count was ≤100x103 µl–1 when removing the aortic clamp, and vice versa if platelet count was >100x103 µl–1. The trigger for each therapy step was ≥60 g blood absorbed from the mediastinal wound area by dry swabs in 5 min. Assignment to two prospective groups was neither randomized nor blinded; Group B (n=5) was treated according to the algorithm, Group C (n=10) received fibrinogen concentrate (Haemocomplettan® P/Riastap, CSL Behring, Marburg, Germany) before the algorithm-based therapy.

Results: A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients. Group C had reduced transfusion [mean 0.7 (range 0–4) u vs 8.5 (5.3) in Group A and 8.2 (2.3) in Group B] and reduced postoperative bleeding [366 (199) ml vs 793 (560) in Group A and 716 (219) in Group B].

Conclusions: In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV–AA.

Keywords: blood, coagulation; measurement techniques, thrombelastograph; surgery, cardiovascular; transfusion


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D. Bolliger, F. Szlam, J. H. Levy, R. J. Molinaro, and K. A. Tanaka
Haemodilution-induced profibrinolytic state is mitigated by fresh-frozen plasma: implications for early haemostatic intervention in massive haemorrhage
Br. J. Anaesth., February 3, 2010; (2010): aeq001v1 - aeq001.
[Abstract] [Full Text] [PDF]


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