Evaluation of fibrinogen concentrate for hemostasis during thoracic aortic surgery (complete republication)

Objective: We investigated whether the coagulation function was improved and bleeding tendency was controlled by fibrinogen concentrate. Methods: In 32 patients with hypofibrinogenemia < 150 mg/dL during either thoracic or thoracoabdominal aortic surgery, blood coagulation ability was observed using ROTEM Sigma® and the 3 min bleeding amount was measured during surgery. Results: The mean blood fibrinogen levels decreased to 109 ± 26 mg/dl at the end of cardiopulmonary bypass, but significantly increased to 231 ± 38 mg/dl after the administration of fibrinogen concentrate (p < 0.0001). The 3 min bleeding amount was 144 ± 88 ml after heparin neutralization, but it significantly decreased to 85 ± 74 ml with fibrinogen concentrate (p = 0.0001). FIBTEM A10 was extremely low at 4.8 ± 2.7 mm after heparin neutralization, but the value increased to 14.1 ± 4.1 mm with fibrinogen concentrate (p < 0.0001). EXTEM A10 (the extrinsic coagulation ability) and INTEM A10 (the intrinsic coagulation ability) were both low at 31.3 ± 11.0 mm and 30.9 ± 10.7 mm, after heparin neutralization, but they both significantly increased to 42.2 ± 8.9 mm and 39.1 ± 8.7 mm (p < 0.0001) with fibrinogen concentrate. There were no operative deaths, but there were three cases in which thromboembolism could not be ruled out. Two patients had myocardial infarction due to occlusion of the reconstructed right coronary artery and the other had newly developed cerebral infarction, but the causes could not be clarified. Conclusion: The administration of fibrinogen concentrate rapidly increased blood fibrinogen levels and significantly reduced the 3 min bleeding amount. In addition, significant improvements in extrinsic and intrinsic coagulation abilities were observed with the administration of fibrinogen concentrate.