Comparison of the Effect of Fibrinogen Concentrate with Fresh Frozen Plasma (FFP) in Management of Hypofibrinogenemic Bleeding After Congenital Cardiac Surgeries: A Clinical Trial Study

Overview

Journal ARYA Atheroscler

Date 2019 May 31

PMID 31143225

Citations 2

Authors

Gholamreza Massoumi

Davoud Mardani

Seyed Masoud Mousavian

Hamid Bigdelian

Affiliations

Soon will be listed here.

Abstract

Background: Hypofibrinogenemia is an independent factor of excessive bleeding after congenital cardiac surgeries. Fresh frozen plasma (FFP) and fibrinogen concentrate are examples of recommended products for management of hypofibrinogenemic bleedings. Unfortunately, there is no study to compare these treatments in pediatric cardiac surgeries. Therefore, this study aimed to compare the effect of fibrinogen concentrate with FFP on postoperative bleeding and clinical outcome after congenital cardiac surgeries in pediatric population.

Methods: Phis prospective clinical trial study was carried out on 90 consecutive pediatric patients who underwent congenital cardiac surgeries. The eligible pediatrics who met our study criteria, randomly received FFP (10 ml/kg) or fibrinogen concentrate (70 mg/kg) to assess postoperative bleeding and blood-products requirements.

Results: Each of FFP and fibrinogen concentrate significantly reduced total chest tube drainage (CTD) at 3, 6, 12, and 24 postoperative hours (P = 0.04). The analysis of time*intervention revealed that our intervention (fibrinogen group) significantly reduced CTD more (P = 0.01). Moreover, fibrinogen group had a significantly higher plasma fibrinogen level in first 24 hours (P = 0.02).

Conclusion: Nowadays, both of fibrinogen concentrate and FFP product are widely used for management of hypofibrinogenic bleedings after cardiac surgeries. According to our results, we concluded that although the both product had a comparable effect on management of hypofibrinogenemic bleeding in pediatrics undergoing congenital cardiac surgeries, choosing better product depended on general condition of patients such as their body fluid status.

Citing Articles

Effects of Fibrinogen Concentrate Supplementation on Postoperative Bleeding in Infants Undergoing Complex Cardiac Surgery.

Rizza A, Pergolizzi C, Benegni S, Giorni C, Raggi V, Iodice F Pediatr Cardiol. 2024; .

PMID: 38980325 DOI: 10.1007/s00246-024-03559-w.

Pediatric Fibrinogen PART II-Overview of Indications for Fibrinogen Use in Critically Ill Children.

Crighton G, Huisman E Front Pediatr. 2021; 9:647680.

PMID: 33968851 PMC: 8097134. DOI: 10.3389/fped.2021.647680.

References

Parr K, Patel M, Dekker R, Levin R, Glynn R, Avorn J . Multivariate predictors of blood product use in cardiac surgery. J Cardiothorac Vasc Anesth. 2003; 17(2):176-81. DOI: 10.1053/jcan.2003.44. View

Oshaughnessy D, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S . Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol. 2004; 126(1):11-28. DOI: 10.1111/j.1365-2141.2004.04972.x. View

Rahe-Meyer N, Pichlmaier M, Haverich A, Solomon C, Winterhalter M, Piepenbrock S . Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study. Br J Anaesth. 2009; 102(6):785-92. PMC: 2683341. DOI: 10.1093/bja/aep089. View

Bolliger D, Szlam F, Molinaro R, Rahe-Meyer N, Levy J, Tanaka K . Finding the optimal concentration range for fibrinogen replacement after severe haemodilution: an in vitro model. Br J Anaesth. 2009; 102(6):793-9. DOI: 10.1093/bja/aep098. View

Solomon C, Pichlmaier U, Schoechl H, Hagl C, Raymondos K, Scheinichen D . Recovery of fibrinogen after administration of fibrinogen concentrate to patients with severe bleeding after cardiopulmonary bypass surgery. Br J Anaesth. 2010; 104(5):555-62. PMC: 2855672. DOI: 10.1093/bja/aeq058. View

Cui Y, Hei F, Long C, Feng Z, Zhao J, Yan F . Perioperative monitoring of thromboelastograph on blood protection and recovery for severely cyanotic patients undergoing complex cardiac surgery. Artif Organs. 2010; 34(11):955-60. DOI: 10.1111/j.1525-1594.2010.01148.x. View

Salvin J, Scheurer M, Laussen P, Wypij D, Polito A, Bacha E . Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay. Ann Thorac Surg. 2010; 91(1):204-10. DOI: 10.1016/j.athoracsur.2010.07.037. View

Kozek-Langenecker S, Sorensen B, Hess J, Spahn D . Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review. Crit Care. 2011; 15(5):R239. PMC: 3334790. DOI: 10.1186/cc10488. View

Ranucci M, Solomon C . Supplementation of fibrinogen in acquired bleeding disorders: experience, evidence, guidelines, and licences. Br J Anaesth. 2012; 109(2):135-7. DOI: 10.1093/bja/aes227. View

10.

Bilecen S, Peelen L, Kalkman C, Spanjersberg A, Moons K, Nierich A . Fibrinogen concentrate therapy in complex cardiac surgery. J Cardiothorac Vasc Anesth. 2012; 27(1):12-7. DOI: 10.1053/j.jvca.2012.06.006. View

11.

Rahe-Meyer N, Solomon C, Hanke A, Schmidt D, Knoerzer D, Hochleitner G . Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial. Anesthesiology. 2012; 118(1):40-50. DOI: 10.1097/ALN.0b013e3182715d4d. View

12.

Solomon C, Hagl C, Rahe-Meyer N . Time course of haemostatic effects of fibrinogen concentrate administration in aortic surgery. Br J Anaesth. 2013; 110(6):947-56. PMC: 3657602. DOI: 10.1093/bja/aes576. View

13.

Kozek-Langenecker S, Afshari A, Albaladejo P, Santullano C, De Robertis E, Filipescu D . Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013; 30(6):270-382. DOI: 10.1097/EJA.0b013e32835f4d5b. View

14.

Yang L, Vuylsteke A, Gerrard C, Besser M, Baglin T . Postoperative fibrinogen level is associated with postoperative bleeding following cardiothoracic surgery and the effect of fibrinogen replacement therapy remains uncertain. J Thromb Haemost. 2013; 11(8):1519-26. DOI: 10.1111/jth.12304. View

15.

Wikkelso A, Lunde J, Johansen M, Stensballe J, Wetterslev J, Moller A . Fibrinogen concentrate in bleeding patients. Cochrane Database Syst Rev. 2013; (8):CD008864. PMC: 6517136. DOI: 10.1002/14651858.CD008864.pub2. View

16.

Faraoni D, Willems A, Savan V, Demanet H, De Ville A, Van Der Linden P . Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery. A retrospective review. Eur J Anaesthesiol. 2014; 31(6):317-26. DOI: 10.1097/EJA.0000000000000043. View

17.

Kindo M, Hoang Minh T, Gerelli S, Perrier S, Meyer N, Schaeffer M . Plasma fibrinogen level on admission to the intensive care unit is a powerful predictor of postoperative bleeding after cardiac surgery with cardiopulmonary bypass. Thromb Res. 2014; 134(2):360-8. DOI: 10.1016/j.thromres.2014.05.008. View

18.

Galas F, de Almeida J, Fukushima J, Vincent J, Osawa E, Zeferino S . Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: a randomized pilot trial. J Thorac Cardiovasc Surg. 2014; 148(4):1647-55. DOI: 10.1016/j.jtcvs.2014.04.029. View

19.

Montan C, Johansson F, Hedin U, Wahlgren C . Preoperative hypofibrinogenemia is associated with increased intraoperative bleeding in ruptured abdominal aortic aneurysms. Thromb Res. 2014; 135(3):443-8. DOI: 10.1016/j.thromres.2014.10.009. View

20.

Levy J, Goodnough L . How I use fibrinogen replacement therapy in acquired bleeding. Blood. 2014; 125(9):1387-93. DOI: 10.1182/blood-2014-08-552000. View