Low Fibrinogen Is Associated with Increased Bleeding-Related Re-exploration after Cardiac Surgery

2017 ◽  
Vol 66 (08) ◽  
pp. 622-628 ◽  
Author(s):  
Yasin Essa ◽  
Natig Zeynalov ◽  
Tim Sandhaus ◽  
Michael Hofmann ◽  
Thomas Lehmann ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Demographic Data ◽  
Linear Regression Analysis ◽  
Postoperative Bleeding ◽  
Plasma Fibrinogen ◽  
Fibrinogen Concentration ◽  
Packed Red Blood Cells ◽  
Initial Surgery ◽  
Multivariable Linear Regression Analysis ◽  
Lactate Levels

Background Re-exploration after cardiac surgery remains a relatively frequent complication associated with adverse effects on outcome. We aimed to identify risk factors for re-exploration. Methods We retrospectively reviewed 2,403 patients having undergone cardiac surgical procedure between January 2013 and December 2014. Re-exploration was required in 114 patients (4.7%). Patients with oral anticoagulation, infective endocarditis, or a clearly identified bleeding source were excluded. Therefore, 42 patients remained for analysis. A matched cohort was selected for age, sex, ejection fraction, creatinine, and procedure out of the non–re-explored patients. Results Demographic data were similar in both groups, except for a higher prevalence of diabetes (45 vs. 21%; p = 0.036) in the non–re-explored patients. Surgery was elective in two-thirds and preoperative plasma fibrinogen concentration was lower in patients requiring re-exploration (2.8 ± 0.9 vs. 3.6 ± 0.9 g/L; p = 0.002). During the initial operation, re-explored patients received more packed red blood cells (1.5 ± 3 vs. 0 ± 1 units; p < 0.001), Postoperatively, re-explored patients had higher lactate levels (1.7 ± 1.4 vs. 1.3 ± 0.6 mmol/L, p = 0.044), more chest tube drainage (1,245 ± 948 vs. 685 ± 413 mL; p < 0.001), higher hospital mortality (19 vs. 7%; p = 0.19), and longer intensive care unit (ICU) stays (8 ± 8 vs. 4 ± 7 days; p = 0.010). In addition, more fibrinogen was administrated during the initial surgery. Plasma fibrinogen concentration upon arrival at the ICU was lower in patients requiring re-exploration (2 ± 0.6 vs. 2.7 ± 0.7 g; p < 0.001). Multivariable linear regression analysis identified fibrinogen upon arrival at the ICU as an independent predictor of postoperative bleeding. Conclusion Cardiac surgery patients with low perioperative plasma fibrinogen concentration appear to be more susceptible to bleeding and re-exploration. Re-exploration in this group of patients is associated with increased morbidity and mortality.

Fibrinogen measurement in cardiac surgery with cardiopulmonary bypass: Analysis of repeatability and agreement of Clauss method within and between six different laboratories

2014 ◽  
Vol 112 (07) ◽  
pp. 109-117 ◽  
Author(s):  
Ekaterina Baryshnikova ◽  
Armando Tripodi ◽  
Christoph J. Schlimp ◽  
Herbert Schöchl ◽  
Janne Cadamuro ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Plasma Fibrinogen ◽  
Detection Methods ◽  
Fibrinogen Concentration ◽  
Plasma Samples ◽  
Limits Of Agreement ◽  
Study Objective ◽  
Standard Operating ◽  
Mean Differences

SummaryPlasma fibrinogen concentration is important for coagulopathy assessment, and is most commonly measured using the Clauss method. Several factors, including device type and reagent, have been shown to affect results. The study objective was to evaluate performance and repeatability of the Clauss method and to assess differences between measurements performed during and after cardiopulmonary bypass (CPB), by testing plasma samples from patients undergoing cardiac surgery with CPB. Samples were collected from 30 patients before surgery, approximately 20 minutes before weaning from CPB, and 5 minutes after CPB and protamine. Fibrinogen concentration was determined using the Clauss method at six quality-controlled specialised laboratories, according to accredited standard operating procedures. Regarding within-centre agreement for Clauss measurement, mean differences between duplicate measurements were between 0.00 g/l and 0.15 g/l, with intervals for 95% limits of agreement for mean Bland-Altman differences up to 1.3 g/l. Regarding between-centre agreement, some mean differences between pairs of centres were above 0.5 g/l. Differences of up to ∼2 g/l were observed with individual samples. Increased variability was observed between centres, with inter-class correlation values below 0.5 suggesting only fair agreement. There were no significant differences in fibrinogen concentration before weaning from CPB and after CPB for most centres and methods. In conclusion, considerable differences exist between Clauss-based plasma fibrinogen measured using different detection methods. Nevertheless, the similarity between measurements shortly before weaning from CPB and after CPB within centres suggests that on-pump measurements could provide an early estimation of fibrinogen deficit after CPB and thus guidance for haemostatic therapy.

scholarly journals Tranexamic acid in cardiac surgery: a systematic review and meta-analysis (protocol)

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028585 ◽  
Author(s):  
Thamer Alaifan ◽  
Ahmed Alenazy ◽  
Dominic Xiang Wang ◽  
Shannon M Fernando ◽  
Jessica Spence ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
Selection Process ◽  
Postoperative Bleeding ◽  
Mean Difference ◽  
Primary Data ◽  
Publication Date ◽  
Eligibility Criteria ◽  
Bowel Infarction ◽  
Packed Red Blood Cells

IntroductionBleeding during cardiac surgery is associated with increased morbidity and mortality. Tranexamic acid is an antifibrinolytic with proven efficacy in major surgeries. Current clinical practice guidelines recommend intraoperative use in cardiac procedures. However, several complications have been reported with tranexamic acid including seizures. This review intends to summarise the evidence examining the efficacy and safety of tranexamic acid in patients undergoing cardiac surgery.Methods/designWe will search MEDLINE, Embase, PubMED, ACPJC, CINAHL and the Cochrane trial registry for eligible randomised controlled trials, the search dates for all databases will be from inception until 1 January 2019, investigating the perioperative use of topical and/or intravenous tranexamic acid as a stand-alone antifibrinolytic agent compared with placebo in patients undergoing open cardiac surgery. We categorised outcomes as patient critical or patient important. Selected patient-critical outcomes are: mortality (intensive care unit, hospital and 30-day endpoints), reoperation within 24 hours, postoperative bleeding requiring transfusion of packed red blood cells, myocardial infarction, stroke, pulmonary embolism, bowel infarction, upper or lower limb deep vein thrombosis and seizures. Those outcomes, we perceived as clinical experts to be most patient valued and patients were not involved in outcomes selection process. We will not apply publication date, language, journal or methodological quality restrictions. Two reviewers will independently screen and identify eligible studies using predefined eligibility criteria and then review full reports of all potentially relevant citations. A third reviewer will resolve disagreements if consensus cannot be achieved. We will present the results as relative risk with 95% CIs for dichotomous outcomes and as mean difference or standardised mean difference for continuous outcomes with 95% CIs. We will assess the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publicationTrial registration numberCRD42018105904

scholarly journals Correlation Between ROTEM FIBTEM Maximum Clot Firmness and Fibrinogen Levels in Pediatric Cardiac Surgery Patients

2018 ◽  
Vol 25 ◽  
pp. 107602961881638 ◽  
Author(s):  
Christopher F. Tirotta ◽  
Richard G. Lagueruela ◽  
Danielle Madril ◽  
Daria Salyakina ◽  
Weize Wang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Linear Regression ◽  
Linear Relationship ◽  
Fibrinogen Level ◽  
Linear Regression Analysis ◽  
Plasma Fibrinogen ◽  
Patient Specific ◽  
Plasma Fibrinogen Level ◽  
Positive Linear Relationship ◽  
Maximum Clot Firmness

This study evaluated whether rotational thromboelastometry (ROTEM; Tem International GmbH, Munich, Germany) FIBTEM maximum clot firmness (MCF) can be used to predict plasma fibrinogen level in pediatric patients undergoing cardiac surgery. Linear regression was conducted to predict plasma fibrinogen level using FIBTEM MCF (0.05 level of significance). Scatter plot with the regression line for the model fit was created. Fifty charts were retrospectively reviewed, and 87 independent measurements of FIBTEM MCF paired with plasma fibrinogen levels were identified for analysis. Linear regression analysis suggested a significant positive linear relationship ( P < .0001) between plasma fibrinogen levels and MCF. Both MCF intercept and slope were significantly correlated with fibrinogen level ( P < .0001). The estimated regression equation (predicted fibrinogen = 78.6 + 12.4 × MCF) indicates that a 1-mm increase in MCF raises plasma fibrinogen level by an average of 12.4 mg/dL. The statistically significant positive linear relationship observed between MCF and fibrinogen levels ( P < .001) suggests that MCF can be used as a surrogate for fibrinogen level. This relationship is of clinical relevance in the calculation of patient-specific dosing of fibrinogen supplementation in this setting.

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

2014 ◽  
Vol 31 (6) ◽  
pp. 317-326 ◽  
Author(s):  
David Faraoni ◽  
Ariane Willems ◽  
Veaceslav Savan ◽  
Helene Demanet ◽  
Andree De Ville ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Plasma Fibrinogen ◽  
Postoperative Blood Loss ◽  
Fibrinogen Concentration

scholarly journals Preoperative plasma fibrinogen level and transfusion in cardiac surgery: a biphasic correlation

2020 ◽  
Vol 31 (5) ◽  
pp. 622-625
Author(s):  
Hélène Charbonneau ◽  
Marie Pasquie ◽  
Nicolas Mayeur
Keyword(s):  
Cardiac Surgery ◽  
Risk Factor ◽  
Retrospective Study ◽  
Fibrinogen Level ◽  
Postoperative Bleeding ◽  
Plasma Fibrinogen ◽  
Plasma Fibrinogen Level ◽  
Single Centre ◽  
Preoperative Status ◽  
Rbc Transfusion

Abstract Coagulopathic bleeding is a serious complication of cardiac surgery. A very low preoperative plasma fibrinogen level (PFL) has been previously described as a risk factor for red blood cell (RBC) transfusion in the perioperative setting. Nevertheless, contradictory results have been published concerning preoperative fibrinogen infusion to decrease RBC transfusion. These results highlight the need for a better description of the relation between preoperative PFL and RBC transfusion. In this single-centre retrospective study, we showed that both high and low PFLs are associated with an increase in RBC transfusion. A pro-inflammatory preoperative status could be involved in the association between high PFL and the increase in RBC transfusion. This non-linear relation between PFL and RBC transfusion could explain the difficulty of decreasing postoperative bleeding using only an algorithm aimed at increasing preoperative PFL.

scholarly journals Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients

2020 ◽  
Vol 5 (3) ◽  
Keyword(s):  
Cardiac Surgery ◽  
Fibrinogen Level ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Plasma Fibrinogen ◽  
Surgical Patients ◽  
Plasma Fibrinogen Level ◽  
Off Pump ◽  
Group A ◽  
Group B

Background: Bleeding is a major concern after cardiac surgery and also a significant cause of morbidity and mortality. Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications. Objective: To find out Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients. Methods: This comparative cross-sectional study was carried out at the Department of Cardiac Surgery in BSMMU hospital from March, 2017 to August, 2019. The study population was 60, with 2 (two) groups having 30 patients in each. Patients from both the groups underwent OPCAB. Statistical analysis of different characteristics between the patients of both groups was done to draw a conclusion. Results: This study total sixty (60) patients who underwent off-pump coronary artery bypass graft surgery were evaluated in this study. Postoperative care at ICU was given to the patients of both groups as per standard hospital protocol. The findings of the study obtained from data analysis presented in the following pages. Among the study population mean age in group A was 55.43±8.53 years and in group B was 59.63±6.86 years. The difference in age between two groups was statistically significant (p<0.05). There was no statistical significance of gender between the two study groups (p>0.05). The mean BMI in group A was 24.13±2.49 kg/m² and that in group B was 24.62±3.71 kg/m². The findings were statistically not significant (p>0.05). Shows the comparison of postoperative variables between group A and B patients. Amount blood loss in 1st 12 hours immediate after surgery in group A and B were 185.67±35.20 ml and 219.67±57.32 ml respectively. Post-operative blood transfusion in group A and B were 2±0.53 units and 2.5±0.68 units respectively, which was statistically significant (p<0.05. There were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. The most valuable predictor for increased postoperative bleeding after OPCAB. Conclusion: In conclusion the efficacy were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. Pearson co-efficient correlation test showed an inverse relationship between plasma fibrinogen level and postoperative bleeding following OPCAB. Fibrinogen concentration level was associated with increased postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting surgical patients.

scholarly journals Preoperative heart failure is not associated with impaired coagulation in paediatric cardiac surgery

2021 ◽  
pp. 1-6
Author(s):  
Fredrik Söderlund ◽  
Håkan Wåhlander ◽  
Emma C. Hansson ◽  
Birgitta S. Romlin
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Heart Defects ◽  
Plasma Fibrinogen ◽  
Fibrinogen Concentration ◽  
Coagulation Parameters ◽  
Normal Ranges ◽  
Elective Repair

Abstract Objective: The objectives of the present study were to determine whether there was any association between the grade of heart failure, as expressed by preoperative levels of brain natriuretic peptide and Ross score, and the preoperative coagulation status in patients with non-restrictive ventricular shunts and determine whether there were any postoperative disturbances of the coagulation system in these patients, as measured by thromboelastometry and standard laboratory analyses of coagulation. Design: Perioperative coagulation was analysed with laboratory-based coagulation tests and thromboelastometry before, 8 hours after, and 18 hours after cardiac surgery. In addition, brain natriuretic peptide was analysed before and 18 hours after surgery. Patients: 40 children less than 12 months old with non-restrictive congenital ventricular or atrio-ventricular shunts scheduled for elective repair of their heart defects. Results: All coagulation parameters measured were within normal ranges preoperatively. There was a significant correlation between brain natriuretic peptide and plasma fibrinogen concentration preoperatively. There was no statistically significant correlation between brain natriuretic peptide and INTEM-MCF, FIBTEM-MCF, plasma fibrinogen, activated partial thromboplastin time, prothrombin time, or platelet count at any other time point, either preoperatively or postoperatively. Postoperatively, fibrinogen plasma concentration and FIBTEM-MCF decreased significantly at 8 hours, followed by a large increase at 18 hours to higher levels than preoperatively. Conclusions: There was no evidence of children with non-restrictive shunts having coagulation abnormalities before cardiac surgery. Brain natriuretic peptide levels or Ross score did not correlate with coagulation parameters in any clinically significant way.

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