Since fibrinogen plays a key role in hemostasis and it is rapidly depleted during cardiac surgery, many cardiac surgeons give fibrinogen to control bleeding during surgery for high-risk patients. The efficacy of this treatment, however, had not been previously confirmed in large, randomized clinical trials. A recent study in the Netherlands randomized 120 high-risk cardiac surgery patients with intraoperative bleeding to receive either fibrinogen concentrate or a placebo during elective surgery. Over 70% of the surgeries were either coronary artery bypass grafts or valve repair or replacements, and the surgeries on average lasted more than three hours. Intraoperative blood loss was similar in both groups—the median blood loss in the patients that received fibrinogen concentrate was 50 mL (IQR 29-100 mL) while the group receiving the placebo lost a median of 70 mL of blood (IQR 33-145 mL; p=0.19). Furthermore, additional adverse events occurred in the patients who received fibrinogen up to 30 days after surgery. With these new data, prophylactic transfusion of fibrinogen concentrate during cardiac surgery should be used sparingly.
Bilecen S, de Groot JA, Kalkman CJ, Spanjersberg AJ, Brandon Bravo Bruinsma GJ, Moons KG, Nierich AP. Effect of Fibrinogen Concentrate on Intraoperative Blood Loss Among Patients With Intraoperative Bleeding During High-Risk Cardiac Surgery: A Randomized Clinical Trial. JAMA 2017;317: 738-47.