The Use of Concentrated Fibrinogen in Cardiac Surgery Patients: a Retrospective Chart Review - Abstract
Purpose: A retrospective chart review was performed to evaluate the effectiveness and safety of fibrinogen concentrate as an additional treatment option for excessive bleeding in cardiac surgery.
Methods: Data from patients receiving fibrinogen concentrate between January 2010 and June 2013 was retrospectively collected from the Maritime Heart Centre database for Cardiac Surgery and from patients’ electronic charts at the Queen Elizabeth II Health Sciences Centre.
Results: In total, data for 50 patients receiving fibrinogen concentrate were collected. On average, patients were 60.7 years of age and 68% were male. Baseline laboratory characteristics were slightly lower than reference ranges, possibly due to the high number of urgent or emergency procedures (36%). Patients received fibrinogen concentrate as an additional line of treatment for bleeding and also received, on average, a total of 8.8 units of blood products: 4.3 units of packed red blood cells, 2.5 units of fresh frozen plasma, 1.5 units of platelets and 0.5 units of cryoprecipitate. The overall transfusion rate was 94%. Two patients (4%) suffered from in-hospital stroke and the overall mortality rate was 18%.
Conclusion: Patients received a relatively high number of blood components despite receiving fibrinogen concentrate as an additional line of treatment for blood loss. As the study was retrospective in nature, it has significant limitations and demonstrates the importance of considering confounding variables, including different transfusion triggers among anesthetists. However, the study does demonstrate the need for a larger-scale randomized prospective study to fully understand the effects of fibrinogen concentrate.