Effects of the Preoperative Administration of a Fibrinogen Concentrate on Bleeding and Transfusion Requirements in Cardiac Surgery

Contact of blood with the cardiopulmonary bypass (CPB) circuit during cardiac surgery induces acquired multifactorial coagulopathy, which results in an increased risk of bleeding and transfusion requirements. In this study, we investigated the effects of the preoperative administration of fibrinogen concentrates on bleeding and transfusion requirements in cardiac surgery. Seventy-eight patients scheduled for elective coronary artery bypass graft (CABG) or valvular surgery were included in this clinical trial between March 2017 and November 2017. The patients were randomly assigned to fibrinogen and control groups. In the fibrinogen group, the patients received 2 g of fibrinogen dissolved in 100 mL of normal saline over a 15-minute period 30 minutes after the induction of anesthesia. In the control group, the patients received the same volume of normal saline during the same period of time. The evaluation of the coagulation system was performed via thromboelastometry (Rotem device). Postoperative bleeding was recorded as the overall mediastinal drainage or the other drainage at the surgical site during a 24-hour period after surgery. The volumes of transfused packed red blood cells, fresh frozen plasma (FFP), and platelet concentrates were recorded. The value of Fibtem-MCF did not show any significant difference between the groups (12.4±4 vs 11.7±4 0.46; P=0.46). The mean volume of bleeding was significantly lower in the fibrinogen group than in the control group (168±12 vs 344±37; P=0.001). The mean volume of the platelet concentrate used was significantly lower in the fibrinogen group than in the control group (P<0.05). However, there was no significant difference in terms of RBCs and FFP consumption between the groups. It appears that although preoperative supplementation with fibrinogen has no effect on transfusion with RBCs and FFP, it results in a reduction in postoperative blood loss and platelet concentrate requirement during cardiac surgery.