EXPERIENCE OF HYPOFIBRINOGENEMIA CORRECTION AFTER CARDIAC SURGERY IN ICU

Abstract

<h3>Objective</h3> Bleeding common complication after cardiac surgery, and requires blood component transfusion. Associated with increased risk of morbidity and mortality and associated costs. The pathophysiology of cardiac surgery-related bleeding is often multifactorial and may include acquired hypofibrinogenemia (fibrinogen level <1.5-2.0 g/L), which exacerbates blood loss. The effectiveness and safety of administering fibrinogen concentrate in cardiac surgery are limited. Studies are limited by their low sample size and large heterogeneity regarding the patient population. On this occasion correction of acquired hypofibrinogenemia in patients after cardiac surgery was initiated in our institution. <h3>Materials and Methods</h3> The research is based on a single-centre study and prospective observation of patients with acquired hypofibrinogenemia after cardiac surgery in an intensive care unit (ICU). Thus, 70 adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) for whom fibrinogen replacement was ordered in response to clinically significant bleeding deemed related to acquired hypofibrinogenemia were selected for the study. Patients were divided into two groups: the first group correction with fibrinogen concentrate and the second group correction with cryoprecipitate. Fibrinogen level was assessed before surgery, after surgery (before correction), and after correction (within 24 hours after correction with fibrinogen concentrate or cryoprecipitate). <h3>Results</h3> In the cryoprecipitate group, 21 patients (60%) were women and 14 (40%) men, mean age was 55±14.26, mean BMI was 28±3.25. In the fibrinogen concentrate group, 17 patients (49%) were women and 18 (51%) men, mean age was 54.14±14.7, mean BMI was 26.9±5.17. The average concentration of fibrinogen before surgery in the group with fibrinogen concentrate was 2.58±0.75 g/l, and in the group with cryoprecipitate, it was 2.38±0.88 g/l. The average concentration of fibrinogen after surgery (before correction) was 1.53±0.22 g/l in the group with fibrinogen concentrate, and in the group, with cryoprecipitate it was 1.4±0.2 g/l The average fibrinogen concentration after correction after 24 hours was 2.3 ± 0.57 g/l in the group with fibrinogen concentrate, and in the group with cryoprecipitate, it was 2.5 ± 0.84 g/l. The average fibrinogen concentration after correction after 48 hours was 3.4 ± 1.5 g/l in the group with fibrinogen concentrate, and in the group with cryoprecipitate it was 3.86 ± 2.62 g/l The average length of stay in the ICU in the group with fibrinogen concentrate was 11.5±24.3 days, and in the group with cryoprecipitate was 17.85±25.6 days. After treatment in the ICU, 32 patients were discharged and 3 died in the fibrinogen concentrate group, and 33 patients were discharged and 2 patients died in the cryoprecipitate group. Mortality in the group with fibrinogen concentrate was 8.5%, and in the group, with cryoprecipitate it was 5.7%. <h3>Conclusion</h3> According to the levels of fibrinogen in plasma, fibrinogen concentrate is as effective as cryoprecipitate in the treatment of hypofibrinogenemia and may be beneficial for patients after cardiac surgery.