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Stéphan F, Gutermann L, Bourget S, Djabarouti S, Berdugo J, Fardini Y, Clerson P, Hébert G, Belmokhtar C. Real-World Experience with a Human Fibrinogen Concentrate: Clinical Data from Adult and Pediatric Patients Requiring Fibrinogen for Bleeding Control and Prevention. J Clin Pharmacol 2023; 63:1186-1196. [PMID: 37293880 DOI: 10.1002/jcph.2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
Human fibrinogen concentrate (Fibryga) received temporary approval for fibrinogen replacement therapy in France (2017), with subsequent full approval for congenital and acquired hypofibrinogenemia. We evaluated real-world use for on-demand treatment of bleeding and prophylaxis to enhance our knowledge on fibrinogen concentrate as an option for fibrinogen replacement. Data were retrospectively collected from adult and pediatric patients with fibrinogen deficiency. The primary end point was indication for fibrinogen concentrate use; the secondary end point was treatment success for on-demand treatment/perioperative prophylaxis. The study included 150 adult (median age, 62 years; range, 18-94 years) and 50 pediatric (median age, 3 years; range, 0.01-17 years) patients with acquired fibrinogen deficiency. Fibrinogen concentrate was administered to 47.3% for nonsurgical bleeding, 22.7% for surgical bleeding, and 30.0% for perioperative prophylaxis in adult patients, and to 4.0% for surgical bleeding and 96.0% for perioperative prophylaxis in pediatric patients. Cardiac surgeries accounted for 79.5%/75.0% perioperative prophylaxis and 82.4%/100.0% surgical bleeding cases in adult/pediatric patients, respectively. The mean ± standard deviation (SD, median) total fibrinogen doses were 3.06 ± 1.69 g (32.61 mg/kg), 2.09 ± 1.36 g (22.99 mg/kg), and 2.36 ± 1.25 g (29.67 mg/kg) for adult nonsurgical bleeding, surgical bleeding, and perioperative prophylaxis, respectively; doses of 0.75 ± 0.35 g (47.64 mg/kg) and 0.83 ± 0.62 g (55.56 mg/kg) were used for pediatric surgical bleeding and perioperative prophylaxis, respectively. Treatment success was 85.7%/97.1/93.3% in adults and 50.0%/87.5% in pediatrics for nonsurgical bleeding (adults only), surgical bleeding, and perioperative prophylaxis, respectively. Fibrinogen concentrate demonstrated favorable effectiveness and safety across the age groups. This study contributes to evidence supporting fibrinogen concentrate for bleeding control/prevention in real-world clinical practice, particularly for patients with acquired fibrinogen deficiency.
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Affiliation(s)
- Francois Stéphan
- Service de Réanimation Adultes, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Loriane Gutermann
- Service Pharmacie et Stérilisation, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | | | - Sarah Djabarouti
- Service Pharmacie, Groupe Hospitalier Sud, CHU de Bordeaux, Pessac, France
| | | | | | | | - Guillaume Hébert
- Service Pharmacie et Stérilisation, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
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Pagnussatt Neto E, Lopes da Costa PD, Gurgel SJT, Schmidt Azevedo P, Modolo NSP, do Nascimento Junior P. Plasma Fibrinogen as a Predictor of Perioperative-Blood-Component Transfusion in Major-Nontraumatic-Orthopedic-Surgery Patients: A Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13050976. [PMID: 36900120 PMCID: PMC10001368 DOI: 10.3390/diagnostics13050976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
There is a trend towards increased perioperative bleeding in patients with plasma fibrinogen levels < 200 mg/dL-1. This study aimed to assess whether there is an association between preoperative fibrinogen levels and perioperative blood-product transfusion up to 48 h after major orthopedic surgery. This cohort study included 195 patients who underwent primary or revision hip arthroplasty for nontraumatic etiologies. Plasma fibrinogen, blood count, coagulation tests, and platelet count were measured preoperatively. A plasma fibrinogen level of 200 mg/dL-1 was the cutoff value used to predict blood transfusion. The mean (SD) plasma fibrinogen level was 325 (83) mg/dL-1. Only thirteen patients had levels < 200 mg/dL-1, and only one of them received a blood transfusion, with an absolute risk of 7.69% (1/13; 95%CI: 1.37-33.31%). Preoperative plasma fibrinogen levels were not associated with the need for blood transfusion (p = 0.745). The sensitivity and the positive predictive value of plasma fibrinogen < 200 mg/dL-1 as a predictor of blood transfusion were 4.17% (95%CI: 0.11-21.12%) and 7.69% (95%CI: 1.12-37.99%), respectively. Test accuracy was 82.05% (95%CI: 75.93-87.17%), but positive and negative likelihood ratios were poor. Therefore, preoperative plasma fibrinogen level in hip-arthroplasty patients was not associated with the need for blood-product transfusion.
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Affiliation(s)
- Eugenio Pagnussatt Neto
- Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil
- São Vicente de Paulo Hospital, Passo Fundo 99010-112, RS, Brazil
- Correspondence: ; Tel.: +55-(54)-99975-7010
| | - Paula Daniele Lopes da Costa
- Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil
| | - Sanderland J. Tavares Gurgel
- Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil
| | - Paula Schmidt Azevedo
- Department of Internal Medicine, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil
| | - Norma S. Pinheiro Modolo
- Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil
| | - Paulo do Nascimento Junior
- Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil
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Fricault P, Piot J, Estève C, Savan V, Sebesteyn A, Durand M, Chavanon O, Albaladejo P. Preoperative fibrinogen level and postcardiac surgery morbidity and mortality rates. Ann Card Anaesth 2022; 25:485-489. [PMID: 36254915 PMCID: PMC9732966 DOI: 10.4103/aca.aca_103_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND High preoperative fibrinogen levels are associated with reduced bleeding rates after cardiac surgery. Fibrinogen is directly involved in inflammatory processes and is a cardiovascular risk factors. Whether high fibrinogen levels before cardiac surgery are a risk factor for mortality or morbidity remains unclear. AIMS This study aimed to examine the association between preoperative fibrinogen levels and mortality and morbidity rates after cardiac surgery. SETTINGS AND DESIGN This is a single-center retrospective study. MATERIAL AND METHODS Patients (n = 1628) were divided into high (HFGr) and normal (NFGr) fibrinogen level groups, based on the cutoff value of 3.3 g/L, derived from the receiver operating characteristic (ROC) curve analysis. The primary outcome was the 30-day mortality rate. The rates of postoperative complications, including postoperative bleeding and transfusion rates, were examined. STATISTICAL ANALYSIS Between-group comparisons were performed with the Mann-Whitney U test and Chi-squared test, as suitable. Model discriminative power was examined with the area under the ROC curve. RESULTS The HFGr and NFGr included 1103 and 525 patients, respectively. Mortality rate was higher in the HFGr than in the NFGr (2.7% vs. 1.1%, P = 0.04). The 12-h bleeding volume (280 mL [195-400] vs. 305 mL [225-435], P = 0.0003) and 24-h bleeding volume values (400 mL [300-550] vs. 450 mL [340-620], P < 0.0001) were lower in the HFGr than in the NFGr. However, the rate of red blood cell transfusion during hospitalization was higher in the HFGr than in the NFGr (21.7% vs. 5.9%, P = 0.0103). Major complications were more frequent in the HFGr than in the NFGr. CONCLUSION High fibrinogen levels were associated with reduced postoperative bleeding volume and increased mortality and morbidity rates.
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Affiliation(s)
- Pierre Fricault
- Department of Anesthesiology and Critical Care, University Hospital, Grenoble, France
| | - Juliette Piot
- Department of Anesthesiology and Critical Care, University Hospital, Grenoble, France
| | - Cécile Estève
- Department of Anesthesiology and Critical Care, University Hospital, Grenoble, France
| | - Veaceslav Savan
- Department of Anesthesiology and Critical Care, University Hospital, Grenoble, France
| | | | - Michel Durand
- Department of Anesthesiology and Critical Care, University Hospital, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiac Surgery, University Hospital, Grenoble, France
| | - Pierre Albaladejo
- Department of Anesthesiology and Critical Care, University Hospital, Grenoble, France
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Hoghooghy A, Honarmand A, Bagheri K, Rezaei K. Evaluation of plasma fibrinogen levels before and after coronary artery bypass graft surgery and its association with the need for blood products. Adv Biomed Res 2022; 11:25. [PMID: 35720218 PMCID: PMC9201223 DOI: 10.4103/abr.abr_22_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 11/12/2022] Open
Abstract
Background: The present study investigated the plasma level of fibrinogen before and after removing the pump in coronary artery bypass graft (CABG) surgery and its relationship with the need for blood products. Materials and Methods: The present study was performed on 60 patients who were candidates for CABG surgery. The fibrinogen level of these patients was assessed and recorded before surgery and immediately after removing the pump. In addition, their hemoglobin level was recorded before the operation and 2 h after. In addition, the number and type of blood products transfusion were recorded intraoperatively and postoperatively and also at the intensive care unit. Results: Patients’ fibrinogen level after removing the pump with the mean of 130.53 ± 122.01 mg/dl decreased significantly compared to before surgery with the mean of mg/dl 224.95 ± 132.88 mg/dl (P < 0.001). In addition, the prognostic value of fibrinogen after removing the pump in determining the postoperative need of blood transfusion showed that the cut-off value of fibrinogen was < 196 mg/dl with a sensitivity of 16.82% and specificity of 80%, but it was not statistically significant (area under the curve [95% confidence interval]: 0.519 [0.350–0.689]; P = 0.825). Conclusion: According to the results of the present study, due to significant changes in fibrinogen levels after removing the pump compared to preoperation, it seems that this factor can play an important role in prognosis of the need to postoperative blood transfusion, although the prognostic value and the critical point mentioned in our study was not significant and it is required to do further studies.
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Lin C, Pan H, Qiao Y, Huang P, Su J, Liu J. Fibrinogen Level Combined With Platelet Count for Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy. Front Neurol 2021; 12:716020. [PMID: 34531815 PMCID: PMC8439152 DOI: 10.3389/fneur.2021.716020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
A serious complication of acute ischemic stroke (AIS) after mechanical thrombectomy (MT) is hemorrhagic transformation (HT), which is potentially associated with clinical deterioration. This study examined predictors of HT following MT in AIS patients. Patients with AIS due to large artery occlusion in the anterior circulation, treated with MT and successfully recanalized (modified Thrombolysis in Cerebral Infarction score 2b/3), were studied retrospectively. HT was evaluated by computed tomography (CT) 24 h after MT and was diagnosed and classified into parenchymal hematoma (PH) and hemorrhagic infarction (HI). Multivariate logistic regression models were used to determine the risk factors for HT. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive utility of risk factors for HT. We enrolled 135 patients: 49 in the HT group and 86 in the non-HT group. The two groups differed significantly in baseline fibrinogen levels (p = 0.003) and platelet counts (p = 0.006). Multivariate logistic regression analyses showed that lower fibrinogen levels [odds ratio (OR), 0.41; 95% CI, 0.23–0.72; p = 0.002] and platelet counts (OR, 0.58; 95% CI, 0.33–0.99; p = 0.048) were independently associated with a higher risk of HT. Together, the binary variates fibrinogen and platelets well-predicted HT (area under the curve, 0.703; specificity, 77.9%; sensitivity, 55.1%). The combination of fibrinogen <2.165 g/L and platelets <171.5 × 109/L was the strongest predictor of HT (OR, 23.17; 95% CI, 5.75–126.80; p < 0.0001). Our study suggests that lower baseline fibrinogen levels and platelet counts may be risk factors for HT in AIS patients following MT and reperfusion. Specifically, the combination of fibrinogen level and platelet count may predict the risk of HT after MT in these patients.
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Affiliation(s)
- Changchun Lin
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Pan
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Qiao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peisheng Huang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingjing Su
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Fibrinogen prophylaxis for reducing perioperative bleeding in patients undergoing radical cystectomy: A double-blind placebo-controlled randomized trial. J Clin Anesth 2021; 73:110373. [PMID: 34098395 DOI: 10.1016/j.jclinane.2021.110373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Excessive bleeding is an important complication of radical cystectomy. We aimed to assess whether preoperative administration of fibrinogen decreases perioperative bleeding and improves the outcome of radical cystectomy. DESIGN Double-blinded randomized trial with two parallel arms. SETTING The study was conducted in the department of surgery at a teaching hospital affiliated with a University of Medical Sciences. PATIENTS In total, 70 men undergoing radical cystectomy were randomized to fibrinogen (n = 35) and placebo-control groups. Mean (SD) age was 64.7 (7.4) years. INTERVENTIONS The intervention group received 2 g fibrinogen concentrate diluted in 100 ml distilled water, and the control group received 100 ml normal saline; both intravenously 15 ̶ 30 min before the start of the surgery. OUTCOME MEASURES The primary outcome was the amount of perioperative blood loss. The secondary outcomes were hemodynamic features and vital signs. MAIN RESULTS Fibrinogen significantly decreased the volume of blood loss (p < 0.001) and the total number of transfused packed-cell units per group (38 vs. 115 units); and compensated the decrease of HCO3 (p = 0.030), the mean arterial pressure (p < 0.001), hemoglobin O2 saturation (p = 0.001), heart rate (p < 0.001), and temperature (p < 0.001) throughout the surgery compared with the placebo. Patients in the fibrinogen group had shorter Intensive Care Unit (p = 0.001) and hospital (p < 0.001) stay. We did not find any adverse reaction in our patients receiving fibrinogen concentrate. CONCLUSION Fibrinogen concentrate reduces perioperative bleeding and the need for blood transfusion in radical cystectomy. It improves the outcomes of the surgery and decreases patients' length of stay in the healthcare system following radical cystectomy. REGISTRATION Iranian Registry of Clinical Trials (IRCT) http://www.irct.ir/, reference number: IRCT20191013045091N1. ETHICS CODE Shahid Beheshti University of Medical Sciences, reference number: IR.SBMU.RETECH.REC.1398.033.
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