Dados do Trabalho

Título

Prophylactic fibrinogen concentrate reduces postoperative bleeding in pediatric cardiac surgery with cardiopulmonary bypass: a randomized study

Objetivo

This trial aimed whether the use of prophylactic fibrinogen concentrate reduces bleeding in congenital heart surgery with cardiopulmonary bypass (CPB).

Métodos

Patients were randomized 1:1 to the treatment group (fibrinogen concentrate) or to the control group (saline 0.9%) after CPB weaning if fibrin-based thromboelastometric clotting assay 10 minutes amplitude (FIBTEM-A10) < 15 mm.

Resultados

Postoperative blood losses. Proportion of patients exposed to allogeneic blood products, assessment of the plasma fibrinogen concentration results and the FIBTEM A-10 levels before and after intervention, and the occurrence of postoperative complications were also analysed. Regarding postoperative bleeding, patients randomized to fibrinogen concentrate had a lower total blood drainage volume compared with the control group (120 vs 210 ml; P=0.019) and lower bleeding in the 1st PO (50 vs 80 ml; P=0.014). There were no differences between groups regarding intraoperative transfusion (P=0.343) or postoperative transfusion (P=0.109). The fibrinogen levels analysed by FIBTEM at time 0 (after CPB) were similar between the groups. Mechanical ventilation was prolonged (11795 min vs 4850 min; P=0.015) and low cardiac output occurred more often in the fibrinogen concentrate group (23.8% vs 0%; P=0.048).

Conclusão

In children undergoing cardiac surgery, the prophylactic use of fibrinogen concentrate can reduce bleeding without increasing the need for allogeneic blood transfusion. Therefore, it may be considered for use in patients at increased risk of bleeding.