The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology.

Erdös, Gabor; Koster, A; Meesters, M I; Ortmann, E; Bolliger, D; Baryshnikova, E; Ahmed, A; Lance, M D; Ravn, H B; Ranucci, M; von Heymann, C; Agarwal, S (2019). The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology. Anaesthesia, 74(12), pp. 1589-1600. Wiley-Blackwell 10.1111/anae.14842

[img] Text
Erdoes_Fibrinogen consensus_Anaesthesia_2019.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (606kB) | Request a copy

To date, data regarding the efficacy and safety of administering fibrinogen concentrate in cardiac surgery are limited. Studies are limited by their low sample size and large heterogeneity with regard to the patient population, by the timing of fibrinogen concentrate administration, and by the definition of transfusion trigger and target levels. Assessment of fibrinogen activity using viscoelastic point-of-care testing shortly before or after weaning from cardiopulmonary bypass in patients and procedures with a high risk of bleeding appears to be a rational strategy. In contrast, the use of Clauss fibrinogen test for determination of plasma fibrinogen level can no longer be recommended without restrictions due to its long turnaround time, high inter-assay variability and interference with high heparin levels and fibrin degradation products. Administration of fibrinogen concentrate for maintaining physiological fibrinogen activity in the case of microvascular post-cardiopulmonary bypass bleeding appears to be indicated. The available evidence does not suggest aiming for supranormal levels, however. Use of cryoprecipitate as an alternative to fibrinogen concentrate might be considered to increase plasma fibrinogen levels. Although conclusive evidence is lacking, fibrinogen concentrate does not seem to increase adverse outcomes (i.e., thromboembolic events). Large prospective multi-centre studies are needed to better define the optimal perioperative monitoring tool, transfusion trigger and target levels for fibrinogen replacement in cardiac surgery.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Erdös, Gabor

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0003-2409

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

14 Oct 2019 08:08

Last Modified:

06 Nov 2019 01:32

Publisher DOI:

10.1111/anae.14842

PubMed ID:

31531856

Uncontrolled Keywords:

cardiac surgery cardiopulmonary bypass fibrinogen fibrinogen concentrate

BORIS DOI:

10.7892/boris.133861

URI:

https://boris.unibe.ch/id/eprint/133861

Actions (login required)

Edit item Edit item
Provide Feedback