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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, Irã
Insights
Prophylactic fibrinogen concentrate significantly reduces postoperative bleeding in patients undergoing coronary artery bypass graft surgery. This intervention improves patient outcomes by minimizing blood loss and the need for transfusions.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Context:
- Postoperative bleeding is a significant complication following coronary artery bypass graft (CABG) surgery.
- It is associated with increased mortality, morbidity, and resource utilization.
- Effective strategies to mitigate bleeding are crucial for patient management.
Purpose:
- To evaluate the efficacy of prophylactic fibrinogen concentrate administration in reducing postoperative bleeding after CABG surgery.
- To compare bleeding volumes and the requirement for blood product transfusions between patients receiving fibrinogen concentrate and placebo.
Summary:
- A prospective, randomized, double-blind study involving 60 patients undergoing CABG surgery.
- Patients received either 1g of fibrinogen concentrate or placebo preoperatively.
- The fibrinogen group exhibited significantly less postoperative bleeding (477±143 mL vs. 703±179 mL) without an increase in thrombotic events.
Impact:
- Prophylactic fibrinogen concentrate administration is an effective strategy to reduce postoperative bleeding in CABG patients.
- This intervention may lead to decreased need for blood product transfusions and improved patient recovery.
- Further research can explore optimal dosing and timing for various surgical procedures.
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 30min 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 72h after surgery.
Conclusion:
Prophylactic fibrinogen reduces post-operative bleeding in patients undergoing coronary artery bypass graft.
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