The Effect of Fibrinogen on Blood Loss After Lumbar Surgery: A Double-Blind Randomized Clinical Trial

Overview

Journal Anesth Pain Med

Publisher Brieflands

Date 2019 Sep 10

PMID 31497522

Citations 4

Authors

Fatemeh Javaherforoosh Zadeh

Farahzad Janatmakan

Mohsen Shafaee Tonekaboni

Mansoor Soltanzadeh

Affiliations

Soon will be listed here.

Abstract

Background: Spinal surgeries often have a high risk of hemorrhage during and after surgery, thus most patients require blood transfusions and blood products. Fibrinogen is used in different forms to control hemorrhage.

Objectives: The present study aimed to evaluate the outcomes of prophylactic fibrinogen administration in reducing hemorrhage after lumbar surgery.

Methods: This was a randomized clinical trial conducted on 30 patients undergoing lumbar surgery. The levels of fibrinogen, as well as hemoglobin (HB), hematocrit (HCT), prothrombin time (PT), partial thromboplastin time (PTT), and INR, were assessed preoperatively as the baseline values. The patients were divided into two groups: intervention (N = 15) and control (N = 15) groups. The intervention group received 1 g fibrinogen dissolved in 50 cc distilled water with surgical incision and the control group received 50 cc distilled water with the surgical incision. At the end of the operation, the volume of hemorrhage transfused blood products (fresh frozen plasma, packed cell, and platelet) was measured. In addition, at 0, 6, and 24 hours after the end of surgery and transfer to recovery, serum levels of fibrinogen, HB, HCT, INR, PT, PTT, and hemovac drain volume were measured.

Results: The hemorrhage during and after the operation in the control group was significantly higher than that of the intervention group (P < 0.05). There were no significant differences between hemoglobin and serum level of fibrinogen before and after surgery between the two groups. The postoperative hypotension showed no significant difference between the two groups.

Conclusions: The findings showed the effectiveness of fibrinogen in reducing acute hemorrhage. Considering the adverse consequences of hemorrhage and coagulopathy in patients undergoing surgery, using fibrinogen as prophylaxis is recommended in surgeries with high risks of hemorrhage.

Citing Articles

Evaluating the Importance of Patient Blood Management During COVID-19 Pandemic.

Chegini A Anesth Pain Med. 2022; 11(6):e112910.

PMID: 35291403 PMC: 8909534. DOI: 10.5812/aapm.112910.

Clinical Applications of Aspirin as a Multi-potent Drug Beyond Cardiovascular Implications: A Proof of Concept for Anesthesiologists- A Narrative Review.

Rezabakhsh A, Mahmoodpoor A, Soleimanpour M, Shahsavarinia K, Soleimanpour H Anesth Pain Med. 2022; 11(5):e118909.

PMID: 35075415 PMC: 8782056. DOI: 10.5812/aapm.118909.

Is Intra-Articular Administration of Fibrinogen Effective in Postoperative Total Knee Arthroplasty Blood Loss? A Randomized Clinical Trial.

Janatmakan F, Javaherforooshzadeh F, Khorrami M, Jarirahmadi S, Khademali H Anesth Pain Med. 2021; 11(1):e107431.

PMID: 34221932 PMC: 8236676. DOI: 10.5812/aapm.107431.

Therapeutic Application of Fibrinogen in Spine Surgery: A Review Article.

Barimani B, Moisan P, Santaguida C, Weber M Int J Spine Surg. 2021; 15(3):549-561.

PMID: 33963032 PMC: 8176831. DOI: 10.14444/8075.

References

Gerlach R, Raabe A, Zimmermann M, Siegemund A, Seifert V . Factor XIII deficiency and postoperative hemorrhage after neurosurgical procedures. Surg Neurol. 2000; 54(3):260-4; discussion 264-5. DOI: 10.1016/s0090-3019(00)00308-6. View

Gerlach R, Tolle F, Raabe A, Zimmermann M, Siegemund A, Seifert V . Increased risk for postoperative hemorrhage after intracranial surgery in patients with decreased factor XIII activity: implications of a prospective study. Stroke. 2002; 33(6):1618-23. DOI: 10.1161/01.str.0000017219.83330.ff. View

Martini W, Chinkes D, Pusateri A, Holcomb J, Yu Y, Zhang X . Acute changes in fibrinogen metabolism and coagulation after hemorrhage in pigs. Am J Physiol Endocrinol Metab. 2005; 289(5):E930-4. DOI: 10.1152/ajpendo.00137.2005. View

Blome M, Isgro F, Kiessling A, Skuras J, Haubelt H, Hellstern P . Relationship between factor XIII activity, fibrinogen, haemostasis screening tests and postoperative bleeding in cardiopulmonary bypass surgery. Thromb Haemost. 2005; 93(6):1101-7. DOI: 10.1160/TH04-12-0799. View

De Lorenzo C, Calatzis A, Welsch U, Heindl B . Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6%. Anesth Analg. 2006; 102(4):1194-200. DOI: 10.1213/01.ane.0000200297.98089.ce. View

Ucar H, Oc M, Tok M, Dogan O, Oc B, Aydin A . Preoperative fibrinogen levels as a predictor of postoperative bleeding after open heart surgery. Heart Surg Forum. 2007; 10(5):E392-6. DOI: 10.1532/HSF98.20071065. View

Karlsson M, Ternstrom L, Hyllner M, Baghaei F, Flinck A, Skrtic S . Prophylactic fibrinogen infusion reduces bleeding after coronary artery bypass surgery. A prospective randomised pilot study. Thromb Haemost. 2009; 102(1):137-44. DOI: 10.1160/TH08-09-0587. View

Karlsson M, Ternstrom L, Hyllner M, Baghaei F, Skrtic S, Jeppsson A . Prophylactic fibrinogen infusion in cardiac surgery patients: effects on biomarkers of coagulation, fibrinolysis, and platelet function. Clin Appl Thromb Hemost. 2010; 17(4):396-404. DOI: 10.1177/1076029610366437. View

Hayakawa M, Sawamura A, Gando S, Kubota N, Uegaki S, Shimojima H . Disseminated intravascular coagulation at an early phase of trauma is associated with consumption coagulopathy and excessive fibrinolysis both by plasmin and neutrophil elastase. Surgery. 2010; 149(2):221-30. DOI: 10.1016/j.surg.2010.06.010. View

10.

Thorarinsdottir H, Sigurbjornsson F, Hreinsson K, Onundarson P, Gudbjartsson T, Sigurdsson G . Effects of fibrinogen concentrate administration during severe hemorrhage. Acta Anaesthesiol Scand. 2010; 54(9):1077-82. DOI: 10.1111/j.1399-6576.2010.02289.x. View

11.

Carling M, Jeppsson A, Wessberg P, Henriksson A, Baghaei F, Brisby H . Preoperative fibrinogen plasma concentration is associated with perioperative bleeding and transfusion requirements in scoliosis surgery. Spine (Phila Pa 1976). 2010; 36(7):549-55. DOI: 10.1097/BRS.0b013e3181d952dc. View

12.

Wafaisade A, Lefering R, Maegele M, Brockamp T, Mutschler M, Lendemans S . Administration of fibrinogen concentrate in exsanguinating trauma patients is associated with improved survival at 6 hours but not at discharge. J Trauma Acute Care Surg. 2013; 74(2):387-3. DOI: 10.1097/TA.0b013e31827e2410. 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.

Shibata Y, Shigemi D, Ito M, Terada K, Nakanishi K, Kato M . Association between fibrinogen levels and severity of postpartum hemorrhage in singleton vaginal deliveries at a Japanese perinatal center. J Nippon Med Sch. 2014; 81(2):94-6. DOI: 10.1272/jnms.81.94. View

16.

Sadeghi M, Atefyekta R, Azimaraghi O, Marashi S, Aghajani Y, Ghadimi F . A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery. Braz J Anesthesiol. 2014; 64(4):253-7. DOI: 10.1016/j.bjane.2013.10.010. View

17.

Davenport R . Coagulopathy following major trauma hemorrhage: lytic, lethal and a lack of fibrinogen. Crit Care. 2014; 18(3):151. PMC: 4075417. DOI: 10.1186/cc13923. View

18.

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

19.

McQuilten Z, Crighton G, Engelbrecht S, Gotmaker R, Brunskill S, Murphy M . Transfusion interventions in critical bleeding requiring massive transfusion: a systematic review. Transfus Med Rev. 2015; 29(2):127-37. DOI: 10.1016/j.tmrv.2015.01.001. View

20.

Payani N, Foroughi M, Dabbagh A . The Effect of Intravenous Administration of Active Recombinant Factor VII on Postoperative Bleeding in Cardiac Valve Reoperations; A Randomized Clinical Trial. Anesth Pain Med. 2015; 5(1):e22846. PMC: 4350162. DOI: 10.5812/aapm.22846. View