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Transfusion and hematologic variables after fibrinogen or platelet transfusion in valve replacement surgery: preliminary data of purified lyophilized human fibrinogen concentrate versus conventional transfusion

Authors

  • Kenichi A. Tanaka,

    Corresponding author
    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
    • Address reprint requests to: Kenichi A. Tanaka, MD, MSc, UPMC Presbyterian, C-215, 200 Lothrop Street, Pittsburgh, PA 15213; e-mail: tanakak@upmc.edu.

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  • Katherine Egan,

    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
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  • Fania Szlam,

    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
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  • Satoru Ogawa,

    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
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  • John D. Roback,

    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
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  • Gautam Sreeram,

    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
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  • Robert A. Guyton,

    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
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  • Edward P. Chen

    1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
    4. Department of Surgery (Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia
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  • The study was supported by CSL Behring GmbH (Marburg, Germany).

Abstract

Background

Platelet (PLT) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (FIB) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first-line FIB replacement and PLT transfusion in post–cardiac surgical bleeding.

Study Design and Methods

In this prospective, randomized, open-label study, 20 adult patients who underwent valve replacement or repair and fulfilled preset visual bleeding scale were randomized to 4 g of FIB or 1 unit of apheresis PLTs. Primary endpoints included hemostatic condition in the surgical field and 24-hour hemostatic product usage. Hematologic data, clinical outcome, and safety data were collected up to the 28th day postoperative visit.

Results

In patients who received the first-line FIB concentrate (n = 10), the visual bleeding scale improved after intervention, and the incidence of PLT transfusion and total plasma donor exposure were lower compared to the PLT group (n = 10). Postintervention FIB level was statistically higher (209 mg/dL vs. 165 mg/dL) in the FIB group than in the PLT group, but PLT count and prothrombin were lower. There were no statistical differences in the postoperative blood loss and red blood cell transfusion between two groups.

Conclusions

Our preliminary data indicate that the primary FIB replacement may potentially reduce the incidence of PLT transfusion and the number of donor exposures. Plasma FIB level of 200 mg/dL is attainable with a single dose of 4 g, and this level seems to mitigate bleeding despite moderately decreased thrombin generation.

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