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A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery
Mostafa Sadeghi1, Reza Atefyekta1, Omid Azimaraghi1
1Tehran University of Medical Sciences, Tehran, Iran.
Insights
Prophylactic fibrinogen concentrate significantly reduces postoperative bleeding in patients undergoing coronary artery bypass graft surgery. This study found lower bleeding volumes in patients receiving fibrinogen compared to placebo, without increasing thrombotic events.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Postoperative bleeding is a significant complication after coronary artery bypass graft (CABG) surgery.
- It increases patient morbidity and mortality.
- Effective strategies to mitigate bleeding are crucial.
Purpose of the Study:
- To evaluate the efficacy of prophylactic fibrinogen concentrate administration.
- To assess its impact on reducing postoperative bleeding in CABG patients.
Main Methods:
- Prospective, randomized, double-blind study involving 60 CABG patients.
- Fibrinogen group received 1g fibrinogen concentrate preoperatively; control group received placebo.
- Monitored postoperative bleeding, coagulation parameters, and blood product transfusion.
Main Results:
- Fibrinogen group showed significantly less postoperative bleeding (477±143 mL vs. 703±179 mL, p=0.0001).
- No significant difference in intra-operative red blood cell transfusion.
- Similar rates of postoperative red blood cell transfusion (15 vs. 21 patients, p=0.094) and no thrombotic events within 72 hours.
Conclusions:
- Prophylactic fibrinogen concentrate is effective in reducing postoperative bleeding after CABG.
- It offers a safe option for managing bleeding in these patients.
Background And Objectives:
Postoperative bleeding has a great clinical importance and can contribute to increased mortality and morbidity in patients undergoing coronary artery bypass graft surgery. In this prospective, randomized, double-blind study, we evaluated the effect of prophylactic administration of fibrinogen concentrate on post-coronary artery bypass graft surgery bleeding.
Methods:
A total of 60 patients undergoing coronary artery bypass surgery were randomly divided into two groups. Patients in the fibrinogen group received 1g of fibrinogen concentrate 30 min prior to the operation, while patients in the control group received placebo. Post-operative bleeding volumes, prothrombin time, partial thromboplastin time, INR, hemoglobin and transfused blood products in both groups were recorded. A strict red blood cell transfusion protocol was used in all patients.
Results:
There were no significant differences between intra-operative packed red blood cells infusion in the studied groups (1.0±1.4 in fibrinogen group, and 1.3±1.1 in control group). Less postoperative bleeding was observed in the fibrinogen group (477±143 versus 703±179, p=0.0001). Fifteen patients in the fibrinogen group and 21 in the control group required post-op packed red blood cells infusion (p=0.094). No thrombotic event was observed through 72 h after surgery.
Conclusion:
Prophylactic fibrinogen reduces post-operative bleeding in patients undergoing coronary artery bypass graft.
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