The influence of circulating levels of fibrinogen and perioperative coagulation parameters on predicting postoperative blood loss in cardiac surgery: a prospective observational study

Pillai, Ravi C., Fraser, John F., Ziegenfuss, Marc and Bhaskar, Balu (2014) The influence of circulating levels of fibrinogen and perioperative coagulation parameters on predicting postoperative blood loss in cardiac surgery: a prospective observational study. Journal of Cardiac Surgery, 29 2: 189-195. doi:10.1111/jocs.12255


Author Pillai, Ravi C.
Fraser, John F.
Ziegenfuss, Marc
Bhaskar, Balu
Title The influence of circulating levels of fibrinogen and perioperative coagulation parameters on predicting postoperative blood loss in cardiac surgery: a prospective observational study
Journal name Journal of Cardiac Surgery   Check publisher's open access policy
ISSN 0886-0440
1540-8191
Publication date 2014-03-01
Year available 2013
Sub-type Article (original research)
DOI 10.1111/jocs.12255
Volume 29
Issue 2
Start page 189
End page 195
Total pages 7
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell
Language eng
Formatted abstract
Background
Fibrinogen, the major clotting protein in blood plasma, plays key roles in blood coagulation and thrombosis. In this prospective cohort study, we measured patient's fibrinogen levels and common coagulation parameters before and after cardiopulmonary bypass (CPB) and examined their relationships with postoperative blood loss.

Study Design

Patients undergoing cardiac surgery with CPB who did not have pre-existing coagulopathy were eligible. Standard blood and coagulation testing were performed before and after CPB. The association of these variables with postoperative blood loss (estimated blood loss from CPB) was assessed with Spearman's ranked correlation and multivariable linear regression models.

Results
Two hundred and fifty patients were enrolled in the study. The median blood loss was 780 mL (range 320–2340 mL). Variables independently associated with increasing blood loss were lower post-CPB platelet counts (p < 0.001), lower postoperative fibrinogen levels (p < 0.001), and larger percent decrease in fibrinogen levels (p < 0.05). There was no correlation between preoperative fibrinogen levels and preoperative coagulation tests with postoperative bleeding. The only significant independent predictors of transfusion in a logistic regression model were postoperative fibrinogen concentration.

Conclusion
Postoperative fibrinogen, the larger percent decrease in fibrinogen, and postoperative platelet levels are markers of bleeding and blood transfusion requirements after CPB than preoperative standard screening tests. Postoperative fibrinogen had the best predictive value of all tests of postoperative blood loss.
Keyword Open heart surgery
Cardiopulmonary bypass
Management
Transfusion
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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