Fibrinogen Concentration Significantly Decreases After On-Pump Versus Off-Pump Coronary Artery Bypass Surgery: A Systematic Point-of-Care ROTEM Analysis

• Published in: Journal of cardiothoracic and vascular anesthesia 2013-02, Vol.27 (1), p.5-11
• Main Authors: Momeni, Mona, MD, Carlier, Cécile, MD, Baele, Philippe, MD, Watremez, Christine, MD, PhD, Van Dyck, Michel, MD, Matta, Amine, MD, Kahn, David, MD, Rennotte, Marie-Thérèse, MD, Glineur, David, MD, PhD, de Kerchove, Laurent, MD, Jacquet, Luc-Marie, MD, PhD, Thiry, Dominique, CCP, Grégoire, André, CCP, Eeckhoudt, Stéphane, PhD, Hermans, Cédric, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; cardiopulmonary bypass; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; coronary artery bypass graft surgery; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - methods; Critical Care; Female; fibrinogen; Fibrinogen - metabolism; Humans; Male; Middle Aged; Point-of-Care Systems; point-of-care test; Postoperative Complications - blood; Postoperative Complications - epidemiology; Prospective Studies; ROTEM; thromboelastography
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2012.07.008

Objectives Studies have emphasized the importance of normal fibrinogen concentrations in surgical patients. The primary hypothesis of this study was that fibrinogen levels significantly decrease in on-pump coronary artery bypass graft (CABG) surgery versus off-pump coronary artery bypass graft (OPCAB) surgery. The second objective was to show that ROTEM (TEM International, GmbH, Munich, Germany) rapidly detects these abnormalities compared with standard tests. Design A prospective, nonrandomized study. Setting A university hospital. Participants Forty-two and 62 patients in the CABG and OPCAB groups, respectively, undergoing first-time bypass surgery were included. Interventions CABG versus OPCAB surgery. Measurements and Main Results Routine coagulation tests and ROTEM values were measured before anesthesia (T0), after the first dose of heparin (T1), after protamine (T2), upon intensive care unit arrival (T3), and 4 hours postoperatively (T4). The outcome measures were followed until 4 hours postoperatively. Fibrinogen concentrations were significantly lower in the CABG versus the OPCAB group at T2 (170 ± 44 v 243 ± 73 mg/dL, p < 0.001) and T3 (179 ± 42 v 232 ± 68 mg/dL, p < 0.001). This was confirmed by significantly lower FIBTEM maximal clot firmness values at T2 (9 ± 4 v 14 ± 5 mm, p < 0.001) and T3 (9 ± 4 v 13 ± 6 mm, p < 0.001). In the CABG group, patients received significantly more transfusions of all blood products except fresh frozen plasma. Conclusions Fibrinogen concentration significantly decreases after cardiopulmonary bypass. ROTEM helps in its fast detection.