A Low-dose Human Fibrinogen is not Effective in Decreasing Postoperative Bleeding and Transfusion Requirements during Cardiac Surgery in Case of Concomitant Clinical Bleeding and Low FIBTEM Values: A Retrospective Matched Study

BACKGROUND: Studies evaluating the hemostatic effects of fibrinogen administration in cardiac surgery are not conclusive. AIMS: We investigated whether the use of a low-dose human fibrinogen in case of clinical bleeding after protamine administration and concomitant low FIBTEM values is effective in reducing postoperative bleeding. Secondary end-point was to investigate the consumption of allogeneic blood products. SETTING AND DESIGN: This was a retrospective matched study conducted at university hospital. MATERIALS AND METHODS: Among 2257 patients undergoing surgery with cardiopulmonary (CPB) bypass, 73 patients received a median dose of 1 g human fibrinogen (ROTEM-Fibri group). This group was matched with 73 patients who had not received human fibrinogen (control group) among 390 patients having undergone surgery at the moment FIBTEM analysis was unavailable. STATISTICAL ANALYSIS: Matching was performed for the type and the presence of redo surgery. McNemar and Wilcoxon paired tests were used to respectively compare the categorical and quantitative variables. RESULTS: The CPB bypass time was significantly higher in the ROTEM-Fibri group (P = 0.006). This group showed significantly higher bleeding in the first 12 and 24 h postoperatively (P < 0.001) and required significantly more transfusion of blood products (P < 0.001) and surgical revision (P = 0.007) when compared with the control group. There was no significant difference in the number of thromboembolic complications. CONCLUSIONS: These results show that the administration of 1 g of fibrinogen based on low-FIBTEM values and clinical bleeding after protamine administration does not stop bleeding and the need for transfusion of allogeneic blood products.