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[Perioperative fibrinogen concentrations in cardiac surgery with cardiopulmonary bypass]
Makiko Uji1, Yuki Terada, Teruo Noguchi
1Department of Anesthesia, Tenri Hospital, Tenri 632-8552.
Insights
Monitoring fibrinogen levels post-cardiac surgery with cardiopulmonary bypass (CPB) is crucial. Maintaining adequate fibrinogen concentration reduces the need for blood products and improves perioperative blood conservation.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Hematology
- Cardiovascular Surgery
Context:
- Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to coagulopathy and increased blood product transfusion.
- Current transfusion strategies are often empiric, lacking targeted biochemical guidance.
- Perioperative bleeding management is a significant challenge in complex surgical procedures.
Purpose:
- To investigate the relationship between perioperative fibrinogen concentration and blood product consumption.
- To evaluate the dynamics of fibrinogen levels during and after cardiopulmonary bypass.
- To determine if fibrinogen levels can guide transfusion therapy for better blood conservation.
Summary:
- Fibrinogen and platelet concentrations were lowest at the end of CPB in 30 patients.
- Fibrinogen levels recovered to pre-CPB levels by the next morning.
- Patients with fibrinogen < 150 mg/dL post-CPB required more blood products than those with fibrinogen > 150 mg/dL.
Impact:
- Fibrinogen level monitoring can optimize perioperative blood transfusion strategies.
- Targeted transfusion based on fibrinogen levels can enhance blood conservation during cardiac surgery.
- This approach may lead to reduced complications and improved patient outcomes.
Background:
Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) need many blood products due to deficiency of coagulation factors. Blood transfusion therapy in patients with excessive bleeding after CPB is generally empiric. We checked and studied the fibrinogen concentration and transfusion, as well as bleeding amount in the perioperative period.
Methods:
The study was approved by our institutional ethics committee. Thirty patients were studied. Blood samples were obtained at the induction of anesthesia (before CPB), at the end of CPB, at the end of operation, and on the next morning, or before the patient was given fresh frozen plasma in the intensive care unit.
Results:
For all cases, fibrinogen concentration and platelet concentration were lowest at the end of CPB. Fibrinogen concentration rose up to before CPB level on the next morning. The group in which fibrinogen concentration was less than 150 mg x dl(-1) at the end of CPB consumed more blood products than the group with fibrinogen concentration of over 150 mg x dl(-1).
Conclusions:
Blood transfusion therapy based on fibrinogen concentration is needed to maintain adequacy of the perioperative blood transfusion and blood conservation in cardiac surgery.
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