Perioperative management
Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: A randomized pilot trial

https://doi.org/10.1016/j.jtcvs.2014.04.029Get rights and content
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Objectives

Acute acquired hypofibrinogenemia in children undergoing cardiac surgery is a major concern because it often results in perioperative bleeding and high rates of allogeneic blood transfusion. Fibrinogen concentrate has been proposed as an alternative to cryoprecipitate (the gold standard therapy), with minimal infectious and immunologic risks. Our objective was to investigate the efficacy and safety of fibrinogen concentrate in children undergoing cardiac surgery.

Methods

In this randomized pilot study, patients were allocated to receive fibrinogen concentrate (60 mg/kg) or cryoprecipitate (10 mL/kg) if bleeding was associated with fibrinogen levels <1 g/dL after cardiopulmonary bypass weaning. The primary outcome was postoperative blood losses during the 48 hours after surgery.

Results

A total of 63 patients were included in the study, 30 in the fibrinogen concentrate group and 33 in the cryoprecipitate group. The median 48-hour blood loss was not significantly different between the 2 groups (320 mL [interquartile range, 157-750] vs 410 mL [interquartile range, 215-510], respectively; P = .672). After treatment, plasma fibrinogen concentration increased similarly following administration of both products. There were no differences in allogeneic blood transfusion after intervention treatment.

Conclusions

A large trial comparing fibrinogen concentrate and cryoprecipitate in the management of children with acute acquired hypofibrinogenemia during heart surgery is feasible. The preliminary results of our study showed that the use of fibrinogen concentrate was as efficient and safe as cryoprecipitate in the management of bleeding children undergoing cardiac surgery.

CTSNet classification

20
21
25
37.3

Abbreviations and Acronyms

CPB
cardiopulmonary bypass
FFP
fresh frozen plasma
FIBTEM
fibrin-based thromboelastometric clotting assay
ICU
intensive care unit
RBC
red blood cell
ROTEM
rotational thromboelastometry

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Disclosures: The trial was supported by CSL Behring Ltd. (Sao Paulo, Brazil), which provided the study drug and the testing of clotting factors and thromboelastometry. Authors have nothing to disclose with regard to commercial support.