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Critical appraisal. Peerachatra Mangmeesri, Thassayu Yuyen and Benno von Bormann August 20. 2013. ‘ A comparison of fibrinogen measurement methods with fibrin clot elasticity assessed by thromboelastometry, before and after administration of fibrinogen concentrate in cardiac surgery patients.’

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slide1

Critical appraisal

Peerachatra Mangmeesri, Thassayu Yuyen and Benno von Bormann

August 20. 2013

‘A comparison of fibrinogen measurement methods with fibrin clot elasticity assessed by thromboelastometry, before and after administration of fibrinogen concentratein cardiac surgery patients.’

Solomon C et al. TRANSFUSION 2011;51:1695-1706

slide2

Purpose: Comparing

Fibrinogen concentration analysis (Clauss)

Viscosity

Conductivity

slide3

Fibrin clot firmness (FIBTEM*)

*Platelet Inhibition!

slide7

Note!

FIBTEM does not analyze the total clotting capacity

slide8

Consecutive Patients (09.2006 – 06.2007)

Cardiac Surgery: ‘Diffuse bleeding’ after ECC (n = 33)

slide9

Hemostyptics – All (33)

Fibrinogen concentrate

6 g (mean)

4 – 13 g (range)

CSL Behring, Marburg (GER)

slide10

Laboratory findings

Fb-C = Fibrinogen concentrate

slide11

Therapeutic measures - Effect

  • Clinic
  • Blood loss – not mentioned
  • Hemodynamics – not mentioned
  • Transfusion (units)
  • 1 PRC: one patient
  • 2 PRC, 6 FFP, 3 Plts: one patient
slide12

von Bormann B, Suksompong S, Zander R:

‘Therapy with fibrinogen concentrate: clinical and ethical considerations’. TRANSFUSION 2013;53:1137-1138

(Comment on Solomon C et al. TRANSFUSION 2011;51:1695)

slide14

German Guidelines 2006/07

“After Fibrinogen therapy the fibrinogen concentration

should beabove 100 mg/dL”

Salomon et al.

slide15

Discussion

Fibrinogen Concentrate – missing issues

Side effects

Anaphylaxis, thromboembolism, viral transmission

Costs

1 g Fibrinogen concentrate ≈ 6,000.- Baht

slide16

Conflict of interest

Five* out of eight

  • *Sponsors
  • CSL Behring, Marburg, GER (Fibrinogen concentrate)
  • Tem International, Munich, GER (Rotem™)