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Critical appraisal

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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Critical appraisal

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  1. 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

  2. Purpose: Comparing Fibrinogen concentration analysis (Clauss) Viscosity Conductivity

  3. Fibrin clot firmness (FIBTEM*) *Platelet Inhibition!

  4. Rotem™, Tem International, Munich (GER)

  5. Note! FIBTEM does not analyze the total clotting capacity

  6. Consecutive Patients (09.2006 – 06.2007) Cardiac Surgery: ‘Diffuse bleeding’ after ECC (n = 33)

  7. Hemostyptics – All (33) Fibrinogen concentrate 6 g (mean) 4 – 13 g (range) CSL Behring, Marburg (GER)

  8. Laboratory findings Fb-C = Fibrinogen concentrate

  9. 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

  10. 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)

  11. German Guidelines 2006/07 “After Fibrinogen therapy the fibrinogen concentration should beabove 100 mg/dL” Salomon et al.

  12. Discussion Fibrinogen Concentrate – missing issues Side effects Anaphylaxis, thromboembolism, viral transmission Costs 1 g Fibrinogen concentrate ≈ 6,000.- Baht

  13. Conflict of interest Five* out of eight • *Sponsors • CSL Behring, Marburg, GER (Fibrinogen concentrate) • Tem International, Munich, GER (Rotem™)

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