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Four-Group Classification Based on Fibrinogen Level and Fibrin Polymerization Associated With Postoperative Bleeding
Shingo Kawashima1, Yuji Suzuki2, Tsunehisa Sato3
1Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Insights
This study introduces a 4-group classification for cardiac surgery patients based on fibrinogen levels and fibrin polymerization, identifying higher bleeding risks in specific groups and improving transfusion management.
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Anesthesiology
Background:
- Perioperative hemostasis is critical in cardiac surgery.
- Fibrinogen and fibrin formation play vital roles in achieving hemostasis.
- Effective management of bleeding complications is essential for patient outcomes.
Purpose of the Study:
- To investigate the association between postoperative bleeding and a combined assessment of fibrinogen levels and fibrin polymerization.
- To evaluate the utility of a novel 4-group classification (Fuji-san classification) in predicting bleeding risk.
- To determine if this classification can optimize perioperative blood transfusion strategies.
Main Methods:
- Retrospective analysis of 215 cardiac surgery patients.
- Classification into 4 groups based on fibrinogen levels (<150 mg/dL) and fibrin polymerization (rotational thromboelastometry <6 mm at 10 minutes).
- Assessment of chest tube drainage volume and intraoperative blood transfusions.
Main Results:
- Groups with hypofibrinogenemia and/or low fibrin polymerization showed significantly increased risk of postoperative bleeding (>500 mL and >1000 mL).
- Group III (hypofibrinogenemia and low fibrin polymerization) had the highest odds ratios for significant bleeding.
- Stratifying fresh frozen plasma administration by the 4-group classification reduced intraoperative blood transfusions by 24.5%.
Conclusions:
- The 4-group classification effectively correlates with postoperative bleeding after cardiac surgery.
- This classification system can aid in identifying high-risk patients and guiding transfusion protocols.
- Implementing this classification may enhance the quality of perioperative blood management in cardiac surgery.
Abstract:
Fibrinogen and fibrin formation have a key role in perioperative hemostasis. The aim of this study is to examine the association of postoperative hemostasis with a combined evaluation of the fibrinogen level and fibrin polymerization in cardiac surgery. We retrospectively classified 215 consecutive cardiac surgery patients into 4 groups (Fuji-san classification) that were divided by fibrinogen level <150 mg/dL (ie, hypofibrinogenemia) and fibrinogen thromboelastometry value at 10 minutes with rotational thromboelastometry <6 mm (ie, low fibrin polymerization) at the warming of cardiopulmonary bypass. Four groups resulted; group I, the acceptable range (n = 85); group II, only hypofibrinogenemia (<150 mg/dL, ≥6 mm, n = 63); group III, hypofibrinogenemia and low fibrin polymerization (<150 mg/dL, <6 mm, n = 60); and group IV, only low fibrin polymerization (≥150 mg/dL, <6 mm, n = 7). The risk of chest tube drainage volume greater than 500 mL within the first 24 hours after surgery (with group I as the reference) was increased in group II (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.5-7.4; P < .01) and group III (OR, 8.5; 95% CI, 3.5-21.7; P < .01), and the risk greater than 1000 mL (with group I as the reference) was increased in group III (OR, 4.0; 95% CI, 1.1-17.3; P = .03) and group IV (OR, 23.1; 95% CI, 3.2-201.0; P < .01). Intraoperative blood transfusions were decreased by 24.5%, after stratifying the starting amount of fresh frozen plasma by the 4-group classification in the recent consecutive 65 (30.2%) patients (P < .01). The 4-group classification is associated with postoperative bleeding and may improve the quality of perioperative blood transfusion in cardiac surgery.
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