Fibrinogen supplementation after cardiac surgery: Insights from the Zero-Plasma trial (ZEPLAST)

M. Ranucci, E. Baryshnikova, H. C. Hemmings

Research output: Contribution to journalArticle

Abstract

Background Fibrinogen supplementation has been proposed both to prevent and treat postoperative bleeding in cardiac surgery. The optimal fibrinogen concentration trigger and target values and the fibrinogen concentrate dose required remain uncertain. This subanalysis of data from the Zero-Plasma Trial (ZEPLAST) assessed target fibrinogen values and the corresponding fibrinogen concentrate dose for supplementation. Methods We performed a post hoc analysis of 116 subjects included in the randomized, placebo-controlled ZEPLAST trail. Data considered were fibrin-based thromboelastometry (FIBTEM) maximum clot firmness (MCF) determined by whole-blood thromboelastometry (ROTEM) before and after placebo or fibrinogen concentrate, Clauss fibrinogen concentration after placebo or fibrinogen concentrate, postoperative bleeding and severe bleeding (SB). The association between FIBTEM MCF and Clauss fibrinogen concentration was tested with linear regression analyses. The predictive value for SB of FIBTEM MCF and Clauss fibrinogen concentration was tested with receiver operating characteristic analyses. Results There was a good association between FIBTEM MCF and Clauss fibrinogen concentration in the baseline study population (r2 = 0.66), which worsened in fibrinogen-supplemented subjects. Both FIBTEM MCF and Clauss fibrinogen concentration yielded a good discriminative power for SB (area under the curve 0.721 and 0.767, respectively). The negative predictive value for SB was 100% for a Clauss fibrinogen concentration of 287 mg dl-1 and 98% for an FIBTEM MCF of 14 mm. Based on these newly defined target values, the dose of fibrinogen concentrate needed would be 3 g lower than the dose used in ZEPLAST. Conclusions A dose of fibrinogen concentrate rarely exceeding 2 g might be sufficient to prevent bleeding in cardiac surgery.

Original languageEnglish
Pages (from-to)618-623
Number of pages6
JournalBritish Journal of Anaesthesia
Volume116
Issue number5
DOIs
Publication statusPublished - May 1 2016

Keywords

  • cardiovascular anaesthesia
  • complications
  • fibrinogen
  • haemorrhage

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Fingerprint Dive into the research topics of 'Fibrinogen supplementation after cardiac surgery: Insights from the Zero-Plasma trial (ZEPLAST)'. Together they form a unique fingerprint.

  • Cite this