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Comparison between the Fibrinogen Clauss Assay and the TEG6S Citrated Functional Fibrinogen in Cardiac Surgery
Terrence Alfred1, Luiz Guilherme Villares da Costa2, Christopher Harle1
1Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada.
Insights
The TEG6s citrated functional fibrinogen (CFF) assay correlates well with the Clauss method pre-cardiac surgery but weakens during bypass. While faster, CFF alone cannot predict bleeding, necessitating further research for transfusion algorithms.
Area of Science:
- Coagulation science
- Transfusion medicine
- Cardiac surgery
Background:
- Fibrinogen is crucial for hemostasis.
- Accurate intraoperative fibrinogen measurement aids clinical decisions.
- The TEG6s citrated functional fibrinogen (CFF) assay offers rapid results.
Purpose of the Study:
- Evaluate the correlation between TEG6s CFF and Clauss fibrinogen assays during cardiac surgery with cardiopulmonary bypass (CPB).
- Assess the utility of CFF for intraoperative decision-making and bleeding prediction.
Main Methods:
- Prospective observational study at a tertiary academic center.
- Twenty adult patients undergoing elective cardiac surgery with CPB.
- Blood samples analyzed using TEG6s CFF and Clauss assays at baseline, during rewarming, and post-protamine.
Main Results:
- Strong correlation between CFF and Clauss at baseline (p < 0.01), weakening during rewarming (p < 0.05).
- TEG6s CFF assay showed significantly faster turnaround times than Clauss.
- CFF values did not reliably predict major postoperative bleeding.
Conclusions:
- TEG6s CFF correlates with Clauss pre-CPB but less so during and after CPB.
- Faster CFF results suggest potential for real-time intraoperative guidance.
- CFF alone is insufficient for predicting postoperative bleeding; further validation is needed.
Objective:
To evaluate the correlation between fibrinogen levels measured by the TEG6s citrated functional fibrinogen (CFF) assay and the standard Clauss method across three phases of cardiac surgery involving cardiopulmonary bypass (CPB), and to assess the potential of CFF for timely clinical decision-making and bleeding prediction.
Design:
A prospective observational study.
Setting:
A single tertiary academic center specializing in cardiac surgery.
Participants:
Twenty adult patients (≥18 years) scheduled for elective cardiac surgery requiring CPB.
Interventions:
Arterial blood samples were collected at three intraoperative time points: (1) baseline (pre-CPB), (2) during CPB at rewarming (core temperature ≥36°C), and (3) 5 minutes post-protamine administration. Each sample was analyzed using both the TEG6s CFF and Clauss fibrinogen assays.
Measurements And Main Results:
A total of 60 paired measurements were obtained. The primary outcome was the correlation between the TEG6s CFF and Clauss fibrinogen values across surgical phases. A strong correlation was observed at baseline (Spearman's ρ = high, p < 0.01), which significantly weakened during rewarming (p < 0.05), and partially recovered post-protamine. Turnaround times for CFF were significantly faster than for Clauss across all phases. However, CFF values alone did not reliably predict major postoperative bleeding (defined as ≥500 mL chest tube output in 24 hours), and neither assay showed statistically significant differences between bleeding and nonbleeding groups.
Conclusion:
The TEG6s CFF assay demonstrates a strong correlation with Clauss fibrinogen levels before CPB, but this relationship weakens during CPB and remains moderate post-protamine administration. Despite limitations during high-heparin states, the TEG6s offers significantly faster results, suggesting utility for real-time intraoperative decision-making. However, CFF values alone are insufficient to predict postoperative bleeding. Further large-scale studies are needed to validate the integration of TEG6s into transfusion algorithms in cardiac surgery.
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