Randomized, double-blinded, placebo-controlled trial of fibrinogen concentrate supplementation after complex cardiac surgery.

POC-, laboratory value-, FFP-, or fibrinogen-based: the number of strategies to diagnose or treat perioperative bleeding disorders is continuously increasing and sometimes antithetical. Therefore, it is quite difficult for the average physician to translate the large amount of different studies into daily clinical practice, especially if the underlying protocols are complex and only partially reflect daily clinical practice.

In contrast to this, Ranucci and coworkers’ approach in this study is straightforward: determine clot firmness and clot initiation by ROTEM technology on cardiopulmonary bypass and substitute what is missing preemptively. Using this approach, the authors could demonstrate convincingly that it is better to avoid bleeding complications in advance rather than to treat massive blood losses afterwards. However, although these results seem crystal-clear, it has to be emphasised that, given the small number of patients enrolled into this study, nothing can be said definitively about the safety of such an approach.

– Jens Meier