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Pre‐operative fibrinogen supplementation in cardiac surgery patients: an evaluation of different trigger values
Author(s) -
RANUCCI M.,
JEPPSSON A.,
BARYSHNIKOVA E.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12469
Subject(s) - medicine , fibrinogen , cutoff , predictive value , surgery , cardiology , gastroenterology , quantum mechanics , physics
Background Pre‐operative fibrinogen levels are negatively associated with postoperative bleeding in cardiac surgery patients. The guidelines of the E uropean S ociety of A naesthesiology consider the possibility of a prophylactic pre‐operative supplementation in patients with fibrinogen levels < 3.8 g/l. The present study is a reanalysis of published data aimed to define the diagnostic accuracy of different values of pre‐operative fibrinogen levels in predicting severe post‐operative bleeding. Methods Data were retrieved for 2154 patients in four different studies. Severe bleeding ( SB ) was defined as a post‐operative chest drain output > 1 l/12 h. Diagnostic accuracy for prediction of SB was tested at three cutoff values of pre‐operative fibrinogen (2.5 g/l, 3.0 g/l, and 3.8 g/l). Results At all the three cutoff values, pre‐operative fibrinogen levels had an excellent negative predictive value, ranging from 86% to 100%. Conversely, the positive predictive value was poor at all the cutoff levels: 12% (3.8 g/l), 14% (3.0 g/l), and 19% (2.5 g/l). Overall, the accuracy of pre‐operative fibrinogen levels for the prediction of SB was poor. A strategy based on pre‐operative fibrinogen supplementation would lead to inappropriate treatment in > 80% of the treated patients. Overall, a trigger value of 3.8 g/l would result in an inappropriate treatment in 52% of the patients, of 3.0 g/l in 20% of the patients, and of 2.5 g/l in 4% of the patients. Conclusion Correction of pre‐operative fibrinogen levels below 3.8 g/l would lead to an excessive rate of inappropriate interventions. Values below 2.5 g/l could be considered.