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Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study.

Rahe-Meyer N, Pichlmaier M, Haverich A, Solomon C, Winterhalter M, Piepenbrock S, Tanaka KA - Br J Anaesth (2009)

Bottom Line: The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration.A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients.In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV-AA.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany. rahe-meyer.niels@mh-hannover.de

ABSTRACT

Background: Bleeding diathesis after aortic valve operation and ascending aorta replacement (AV-AA) is managed with fresh-frozen plasma (FFP) and platelet concentrates. The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration.

Methods: A blood products transfusion algorithm was developed using retrospective data from 42 elective patients (Group A). Two units of platelet concentrate were transfused after cardiopulmonary bypass, followed by 4 u of FFP if bleeding persisted, if platelet count was < or =100 x 10(3) microl(-1) when removing the aortic clamp, and vice versa if platelet count was >100 x 10(3) microl(-1). The trigger for each therapy step was > or =60 g blood absorbed from the mediastinal wound area by dry swabs in 5 min. Assignment to two prospective groups was neither randomized nor blinded; Group B (n=5) was treated according to the algorithm, Group C (n=10) received fibrinogen concentrate (Haemocomplettan P/Riastap, CSL Behring, Marburg, Germany) before the algorithm-based therapy.

Results: A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients. Group C had reduced transfusion [mean 0.7 (range 0-4) u vs 8.5 (5.3) in Group A and 8.2 (2.3) in Group B] and reduced postoperative bleeding [366 (199) ml vs 793 (560) in Group A and 716 (219) in Group B].

Conclusions: In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV-AA.

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Related in: MedlinePlus

Flow chart of transfusion algorithm. FFP, fresh-frozen plasma; PC, platelet concentrates; PLT, platelet count (×103 µl−1); u, unit.
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AEP089F1: Flow chart of transfusion algorithm. FFP, fresh-frozen plasma; PC, platelet concentrates; PLT, platelet count (×103 µl−1); u, unit.

Mentions: Retrospective data from all 42 patients undergoing elective AV–AA in 2006 selected according to the inclusion and exclusion criteria were obtained from medical records (Group A). Patients had been transfused without a standardized transfusion protocol or point-of-care laboratory testing, and had received on average 4 u of FFP and 2 u of platelet concentrate during and the first 24 h after the operation. On the basis of these data and on algorithms described in the literature,1415 a two-step blood products transfusion algorithm for patients undergoing AV–AA was developed (Fig. 1).


Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study.

Rahe-Meyer N, Pichlmaier M, Haverich A, Solomon C, Winterhalter M, Piepenbrock S, Tanaka KA - Br J Anaesth (2009)

Flow chart of transfusion algorithm. FFP, fresh-frozen plasma; PC, platelet concentrates; PLT, platelet count (×103 µl−1); u, unit.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2683341&req=5

AEP089F1: Flow chart of transfusion algorithm. FFP, fresh-frozen plasma; PC, platelet concentrates; PLT, platelet count (×103 µl−1); u, unit.
Mentions: Retrospective data from all 42 patients undergoing elective AV–AA in 2006 selected according to the inclusion and exclusion criteria were obtained from medical records (Group A). Patients had been transfused without a standardized transfusion protocol or point-of-care laboratory testing, and had received on average 4 u of FFP and 2 u of platelet concentrate during and the first 24 h after the operation. On the basis of these data and on algorithms described in the literature,1415 a two-step blood products transfusion algorithm for patients undergoing AV–AA was developed (Fig. 1).

Bottom Line: The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration.A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients.In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV-AA.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany. rahe-meyer.niels@mh-hannover.de

ABSTRACT

Background: Bleeding diathesis after aortic valve operation and ascending aorta replacement (AV-AA) is managed with fresh-frozen plasma (FFP) and platelet concentrates. The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration.

Methods: A blood products transfusion algorithm was developed using retrospective data from 42 elective patients (Group A). Two units of platelet concentrate were transfused after cardiopulmonary bypass, followed by 4 u of FFP if bleeding persisted, if platelet count was < or =100 x 10(3) microl(-1) when removing the aortic clamp, and vice versa if platelet count was >100 x 10(3) microl(-1). The trigger for each therapy step was > or =60 g blood absorbed from the mediastinal wound area by dry swabs in 5 min. Assignment to two prospective groups was neither randomized nor blinded; Group B (n=5) was treated according to the algorithm, Group C (n=10) received fibrinogen concentrate (Haemocomplettan P/Riastap, CSL Behring, Marburg, Germany) before the algorithm-based therapy.

Results: A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients. Group C had reduced transfusion [mean 0.7 (range 0-4) u vs 8.5 (5.3) in Group A and 8.2 (2.3) in Group B] and reduced postoperative bleeding [366 (199) ml vs 793 (560) in Group A and 716 (219) in Group B].

Conclusions: In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV-AA.

Show MeSH
Related in: MedlinePlus