Time course of haemostatic effects of fibrinogen concentrate administration in aortic surgery.

Salomon and co-workers present a post-hoc analysis of data originating from a single-center, phase 2, prospective, randomized, double-blind, placebo-controlled clinical study in 61 patients undergoing thoracoabdominal on-pump aortic replacement surgery (Anesthesiology 2012;118:40-50).

Focus was on the evolution (end of surgery, postop days 1, 2 and 10) of the plasma fibrinogen concentration after intraoperative substitution of 6 (5-8) g fibrinogen concentrate (n = 14), fresh frozen plasma plus 8 (8-10) g fibrinogen concentrate (n = 15) or fresh frozen plasma alone (“control group”, n = 32).

Despite the fact that plasma fibrinogen concentration should increase postoperatively, reflecting an acute phase inflammatory reaction, postoperative plasma fibrinogen concentrations were comparable between the different patient groups. The administration of fibrinogen concentrate did not lead to higher plasma fibrinogen concentrations than the infusion of fresh frozen plasma. However, during the 24-hour period after start of study medication, the median transfusion of allogeneic blood components was reduced by 85% in patients of the fibrinogen group. A total avoidance of allogeneic transfusion was achieved in 45% of patients in the fibrinogen group and in 0% of patients in the control group.

In the setting presented, the observed increase of plasma fibrinogen concentration after fibrinogen substitution was only short-lived and comparable to the administration of fresh frozen plasma. However, the allogeneic blood transfusion sparing effect was significant in patients treated with fibrinogen concentrate.

– Oliver Habler