A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery

Mostafa Sadeghi; Reza Atefyekta; Omid Azimaraghi; Seyed Mojtaba Marashi; Yasaman Aghajani; Fatemeh Ghadimi; Donat R. Spahn; Ali Movafegh

doi:10.1016/j.bjane.2013.10.010

Scientific Article

A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery

Estudo randômico e duplo-cego de profilaxia com fibrinogênio para reduzir o sangramento em cirurgia cardíaca

Mostafa Sadeghi; Reza Atefyekta; Omid Azimaraghi; Seyed Mojtaba Marashi; Yasaman Aghajani; Fatemeh Ghadimi; Donat R. Spahn; Ali Movafegh

http://dx.doi.org/10.1016/j.bjane.2013.10.010 Braz J Anesthesiol, vol.64, n4, p.253-257, 2014

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Abstract

BACKGROUND AND OBJECTIVES: Postoperative bleeding has a great clinical importance and can contribute to increased mortality and morbidity in patients undergoing coronary artery bypass graft surgery. In this prospective, randomized, double-blind study, we evaluated the effect of prophylactic administration of fibrinogen concentrate on post-coronary artery bypass graft surgery bleeding. METHODS: A total of 60 patients undergoing coronary artery bypass surgery were randomly divided into two groups. Patients in the fibrinogen group received 1 g of fibrinogen concentrate 30 min prior to the operation, while patients in the control group received placebo. Post-operative bleeding volumes, prothrombin time, partial thromboplastin time, INR, hemoglobin and transfused blood products in both groups were recorded. A strict red blood cell transfusion protocol was used in all patients. RESULTS: There were no significant differences between intra-operative packed red blood cells infusion in the studied groups (1.0 ± 1.4 in fibrinogen group, and 1.3 ± 1.1 in control group). Less postoperative bleeding was observed in the fibrinogen group (477 ± 143 versus 703 ± 179, p = 0.0001). Fifteen patients in the fibrinogen group and 21 in the control group required post-op packed red blood cells infusion (p = 0.094). No thrombotic event was observed through 72 h after surgery. CONCLUSION: Prophylactic fibrinogen reduces post-operative bleeding in patients undergoing coronary artery bypass graft.

Keywords

Blood transfusion, Bleeding, Cardiac surgery, Cardiopulmonary bypass, Hemostasis

Resumo

JUSTIFICATIVA E OBJETIVO: a hemorragia no período pós-operatório é de grande importância clínica e pode contribuir para o aumento da morbidade e mortalidade em pacientes submetidos à cirurgia de revascularização coronária. Nesse estudo prospectivo, randômico e duplo-cego, avaliamos o efeito da administração profilática de concentrado de fibrinogênio sobre o sangramento após cirurgia de revascularização coronária. MÉTODOS: no total, 60 pacientes submetidos à cirurgia de revascularização coronária foram randomicamente divididos em dois grupos. Os pacientes do grupo fibrinogênio receberam 1 g de concentrado de fibrinogênio 30 minutos antes da operação, enquanto os doentes do grupo controle receberam placebo. Os volumes de sangramento no pós-operatório, tempo de protrombina, tempo de tromboplastina parcial, INR, hemoglobina e hemoderivados transfundidos em ambos os grupos foram registrados. Um protocolo de conduta rigoroso para transfusão de hemácias foi usado em todos os pacientes. RESULTADOS: não houve diferenças significantes entre as infusões de concentrados de hemácias nos grupos estudados (1,0 ± 1,4 no grupo fibrinogênio e 1,3 ± 1,1 no grupo controle). O grupo fibrinogênio apresentou menos sangramento no pós-operatório (477 ± 143 versus 703 ± 179, p = 0,0001). Quinze pacientes do grupo fibrinogênio e 21 do grupo controle precisaram de infusão de concentrado de hemácias no pós-operatório (p = 0,094). Evento trombótico não foi observado durante 72 h após a cirurgia. CONCLUSÃO: profilaxia com fibrinogênio reduz o sangramento no período pós-operatório de pacientes submetidos à revascularização coronária.

Palavras-chave

Transfusão de sangue, Sangramento, Cirurgia cardíaca, Circulação extracorpórea, Hemostasia

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A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery

Estudo randômico e duplo-cego de profilaxia com fibrinogênio para reduzir o sangramento em cirurgia cardíaca

Mostafa Sadeghi; Reza Atefyekta; Omid Azimaraghi; Seyed Mojtaba Marashi; Yasaman Aghajani; Fatemeh Ghadimi; Donat R. Spahn; Ali Movafegh

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