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Fibrinogen recovery and changes in fibrin‐based clot firmness after cryoprecipitate administration in patients undergoing aortic surgery involving deep hypothermic circulatory arrest
Author(s) -
Lee Sang Hyun,
Lee Sangmin M.,
Kim Chung Su,
Cho Hyun Sung,
Lee JongHwan,
Lee Cheol Hee,
Kim Eunhee,
Sung Kiick,
Solomon Cristina,
Kang Jingu,
Kim Young Ri
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12479
Subject(s) - cryoprecipitate , thromboelastometry , fibrinogen , medicine , fibrin , cardiopulmonary bypass , anesthesia , deep hypothermic circulatory arrest , prothrombin complex concentrate , surgery , cardiology , warfarin , immunology , cerebral perfusion pressure , cerebral blood flow , atrial fibrillation
Background Cryoprecipitate may be used to treat bleeding in cardiac surgery. Its effects on plasma fibrinogen and fibrin clotting in this setting are poorly defined. Study Design And Methods Patients undergoing on‐pump aortic surgery with deep hypothermic circulatory arrest ( DHCA ) were recruited prospectively. After protamine reversal, cryoprecipitate was administered to patients with bleeding, and fibrin deficit was indicated by thromboelastometry ( ROTEM )‐based FIBTEM test. Coagulation was assessed using ROTEM ‐based tests and standard laboratory tests before and after cryoprecipitate. Results Thirteen patients were included. Cryoprecipitate significantly elevated EXTEM A10 from (mean ± standard deviation) 29.4 ± 5.8 to 34.8 ± 5.9 mm (p = 0.01), FIBTEM A10 from 3.5 ± 0.9 to 5.8 ± 1.7 mm (p = 0.04), and plasma fibrinogen concentration from 154.2 ± 25.6 to 193.4 ± 30.5 mg/dL (p = 0.01). EXTEM clot elasticity at 10 minutes (CE10) increased from 42.5 ± 12.0 to 54.7 ± 14.9 mm after cryoprecipitate (30.0% increase). FIBTEM CE10 increased from 3.7 ± 0.9 to 6.2 ± 2.0 mm (53.0% increase). A fibrinogen dose of 13.2 ± 5.2 mg/kg was required to increase FIBTEM A10 by 1 mm. In vivo recovery of fibrinogen was 61.6 ± 31.2%. Conclusions Cryoprecipitate increased plasma fibrinogen levels and fibrin‐based clotting in bleeding patients undergoing aortic surgery with DHCA . In vivo recovery of fibrinogen was considerably below 100% and fibrinogen content varied between cryoprecipitate units. Trials are needed to assess whether cryoprecipitate impacts clinical outcomes and to evaluate its safety.