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 ◽  
...  

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.

1979 ◽  
Author(s):  
K.A. Rickard ◽  
J. Burridge ◽  
T. Exner ◽  
P. Power

An assessment of fibrinogen concentration is basic to any investigation of clotting dysfunction and often an estimate of fibrinogen level is needed rapidly as an indication of consumptive coagulopathy or fibrinolysis. Fibrinogen levels in a variety of clinical plasma samples were assessed concurrently by several methods. Results were correlated against a reference method based on Ancrod-clottable fibrinogen and calibrated by U.V. absorbance with alkaline solutions of carefully dried fibrin standard. The best correlations with the reference method were achieved by an immunologic method using the Centrifichem principle and by heat precipitation with quantitation by packing in micro-haematocrit tubes. A modified clot opacity method also gave acceptable results. The turbidimetric ammonium sulphate and sodium sulphite precipitation methods correlated less well with the reference method, and in particular the sodium sulphite technique gave high apparent fibrinogen levels with jaundiced plasmas. Neither of the turbidimeteric methods were useful for fibrinogen levels below 50mg/dl. The thrombin time method showed excellent sensitivity to fibrinogen, even at very low fibrinogen levels, but did not correlate well with the reference method. This apparently conflicts with the findings of a recent CAP survey which strongly favoured the thrombin time method. We believe there is a danger that such surveys promote test methods on which there is good inter-labotatory agreement, but which may not be specific in function.


2017 ◽  
Vol 66 (08) ◽  
pp. 622-628 ◽  
Author(s):  
Yasin Essa ◽  
Natig Zeynalov ◽  
Tim Sandhaus ◽  
Michael Hofmann ◽  
Thomas Lehmann ◽  
...  

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.


2014 ◽  
Vol 31 (6) ◽  
pp. 317-326 ◽  
Author(s):  
David Faraoni ◽  
Ariane Willems ◽  
Veaceslav Savan ◽  
Helene Demanet ◽  
Andree De Ville ◽  
...  

1979 ◽  
Author(s):  
K Rickard ◽  
J Burridge ◽  
T Exner ◽  
P Power

An assessment of fibrinogen concentration is basic to any investigation of clotting dysfunction and often an estimate of fibrinogen level is needed rapidly as an indication of consumptive coagulopathy or fibrinolysis. Fibrinogen levels in a variety of clinical plasma samples were assessed concurrently by several methods. Results were correlated against a reference method based on Ancrod-clottable fibrinogen and calibrated by U.V. absorbance with alkaline solutions of carefully dried fibrin standard. The best correlations with the reference method were achieved by an immunologic method using the Centrifichem principle and by heat precipitation with quantitation by packing in micro-haematocrit tubes. A modified clot opacity method also gave acceptable results. The turbidimetric ammonium sulphate and sodium sulphite precipitation methods correlated less well with the reference method, and in particular the sodium sulphite technique gave high apparent fibrinogen levels with jaundiced plasmas. Neither of the turbidimetric methods were useful for fibrinogen levels below 50mg/dl. The thrombin time method showed excellent sensitivity to fibrinogen, even at very low fibrinogen levels, but did not correlate well with the reference method. This apparently conflicts with the findings of a recent CAP survey which strongly favoured the thrombin time method. We believe there is a danger that such surveys promote test methods on which there is good interlaboratory agreement, but which may not be specific in function.


2018 ◽  
Vol 9 (4) ◽  
pp. 424-433 ◽  
Author(s):  
John P. Scott ◽  
Robert A. Niebler ◽  
Eckehard A. E. Stuth ◽  
Debra K. Newman ◽  
James S. Tweddell ◽  
...  

Background: Thrombocytopenia and hypofibrinogenemia during neonatal cardiopulmonary bypass (CPB) contribute to bleeding and morbidity. Rotational thromboelastometry (ROTEM) is a viscoelastic assay with a rapid turnaround time. Data validating ROTEM during neonatal cardiac surgery remain limited. This study examined perioperative hemostatic trends in neonates treated with standardized platelet and cryoprecipitate transfusion during CPB. We hypothesized that ROTEM would predict thrombocytopenia, hypofibrinogenemia, and the correction thereof. Methods: Forty-four neonates undergoing CPB were included in this prospective observational study. Blood samples were obtained at Baseline, On CPB, Post-CPB, and Postoperative. The ROTEM analysis included extrinsically activated (Extem) and fibrinogen-specific (Fibtem) assays. Platelet-specific thromboelastometry (Pltem) values were calculated. Platelet and cryoprecipitate transfusion was initiated prior to termination of CPB. Results: Platelet count and Extem amplitude decreased significantly On CPB ( P < .0001), increased significantly Post-CPB ( P < .0001), and Postoperative values were not significantly different from Baseline. Extem amplitude at 10 minutes (A10) > 46.5 mm (AUC = 0.941) and Pltem A10 > 37.5 mm [area under curve (AUC) = 0.960] predicted platelet count > 100 × 103/μL, and they highly correlated with platelet count ( R = 0.89 and R = 0.90, respectively). Fibrinogen concentration and Fibtem amplitude decreased significantly On CPB ( P ≤ .0001) and normalized after cryoprecipitate transfusion. Fibtem A10 > 9.5 mm predicted fibrinogen >200 mg/dL (AUC = 0.817), but it correlated less well with fibrinogen concentration ( R = 0.65). Conclusions: ROTEM analysis during neonatal cardiac surgery is sensitive and specific for thrombocytopenia and hypofibrinogenemia, identifying deficits within 10 minutes. Platelet and cryoprecipitate transfusion during neonatal CPB normalizes platelet count, fibrinogen level, and ROTEM amplitudes.


2021 ◽  
pp. 1-6
Author(s):  
Fredrik Söderlund ◽  
Håkan Wåhlander ◽  
Emma C. Hansson ◽  
Birgitta S. Romlin

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.


Sign in / Sign up

Export Citation Format

Share Document