Abstract
Purposes: Hypofibrinogenemia is usually complicated with severe and massive upper gastrointestinal (GI) bleeding, especially in liver cirrhosis. In Japan, neither fibrinogen concentrate nor cryoprecipitate (CRYO) is available for cases of acquired hypofibrinogenemia to recover the hemostatic level of fibrinogen rapidly. We prepared and produced in-house CRYO from fresh frozen plasma, and compared mortality between pre-implementation and post-implementation of CRYO. Methods: We performed a retrospective cohort study of patients admitted to our single tertiary medical center with upper GI bleeding from January 2011 to December 2016. The observational control period was from January 2011 to February 2013. From March 2013 to December 2016, we implemented the transfusion of CRYO, which was prepared and produced in our hospital. Clinical outcomes were compared between the patients in the two periods. Patients: Eleven patients in the control period and 10 in the intervention period were eligible for analysis. Results: In-hospital mortality (55% vs. 20%, P = 0.238) and mortality within 24 hour after admission (27% vs. 0%, P = 0.246) tended to be lower in the intervention period than in the control period, although the patients had more severe coagulation on admission than those in the control period. The plasma fibrinogen level before the treatment of hemostasis in the intervention period was higher than that in the control period (80 ± 9 mg/dL vs. 127 ± 15 mg/dL, P Conclusion: Implementation of in-house CRYO transfusion may reduce the rate of mortality due to severe upper GI bleeding.
Highlights
Fresh frozen plasma (FFP) is commonly used to correct acquired hypofibrinogenemia due to massive hemorrhage as a result of trauma, postpartum hemorrhage, and other conditions, as neither fibrinogen concentrate nor cryoprecipitate (CRYO) is available in Japan
In-hospital mortality (55% vs. 20%, P = 0.238) and mortality within 24 hour after admission (27% vs. 0%, P = 0.246) tended to be lower in the intervention period than in the control period, the patients had more severe coagulation on admission than those in the control period
Implementation of in-house CRYO transfusion may reduce the rate of mortality due to severe upper GI bleeding
Summary
Fresh frozen plasma (FFP) is commonly used to correct acquired hypofibrinogenemia due to massive hemorrhage as a result of trauma, postpartum hemorrhage, and other conditions, as neither fibrinogen concentrate nor cryoprecipitate (CRYO) is available in Japan. Compared with FFP, CRYO and fibrinogen concentrate can theoretically recover the normal values of fibrinogen in the patients with acquired hypofibrinogenemia immediately [3]. Accepted indications for the use of CRYO include but are not limited to hypofibrinogenemia, t-plasminogen activator-related life-threatening hemorrhage, and massive transfusion (red blood cell [RBC] solution > 10 U in 24 hours with continued bleeding) [4]. Nascimetro et al reported that CRYO was most commonly used to replace the fibrinogen levels in patients with acquired coagulopathy, such as in the clinical settings with hemorrhage, including trauma, cardiac surgery, liver transplantation, or obstetric hemorrhage [5]. The optimal transfusion strategy to treat acute hypofibrinogenemia after severe upper gastrointestinal (GI) bleeding has only been investigated in a few clinical studies, and guidelines of its kind on CRYO or the fibrinogen concentrate do not exist in Japan
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