THE EFFECT OF FIBRINOGEN INFUSION APPLIED AFTER CARDIOPULMONARY BYPASS ON BLEEDING IN CORONARY ARTERY BYPASS GRAFT SURGERY: RETROSPECTIVE COMPARATIVE STUDY

Year 2022, Volume: 23 Issue: 4, 392 - 398, 17.10.2022

Ümit Arslan , Ali İhsan Tekin , Ferhat Borulu , Ziya Yıldız , Mehmet Tort , Bilgehan Erkut

https://doi.org/10.18229/kocatepetip.986997

Abstract

OBJECTIVE: The effect of administered fibrinogen concentrates in reducing the risk of postoperative bleeding that remains a serious problem in open heart surgery is controversial. We aimed to present the effect of fibrinogen concentrates on postoperative bleeding applied after cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG).
MATERIAL AND METHODS: 67 patients who underwent CABG and measured below 2.5 g / L fibrinogen after CPB were included in the study. Data of 32 patients (Group F; n=32 patients) who were given fibrinogen concentrate were compared with 35 patients (Group NF; n=35 patients) who were not given fibrinogen concentrate.
RESULTS: After CPB, fibrinogen concentrate was applied to patients in order to increase fibrinogen levels to 2.5 g/L and above. For both groups, fibrinogen levels decreased significantly after CPB compared to preoperative levels (p<0.01), however, there was no difference between the groups in terms of reduction rate (p = 0.321). 2.94±0.91 g fibrinogen was administered to the patients in Group F. Postoperative drainage between the groups was not significant in both the 0-12 hour period (p=0.142) and 12-24 hour period(p = 0.309).
CONCLUSIONS: Fibrinogen concentrate may reduce the amount of postoperative drainage with secondary effects which increased low plasma fibrinogen levels and contributes to recovery of coagulation physiology. However, because this decrease was not statistically significant, we think that fibrinogen concentrates should be used only in patients with a high risk of bleeding and in patients with fibrinogen levels below <1.5 g/L after CPB.

Keywords

Fibrinogen, Coronary artery bypass graft, Postoperative bleeding

KORONER ARTER BAYPAS GERFT OPERASYONLARINDA KARDİYOPULMONER BAYPASTAN SONRA UYGULANAN FİBRİNOJEN İNFÜZYONUNUN KANAMA ÜZERİNE ETKİSİ: RETROSPEKTİF KARŞILAŞTIRMALI ÇALIŞMA

Abstract

AMAÇ: Açık kalp cerrahisinde ciddi bir sorun olmaya devam eden postoperatif kanamanın riskini azaltmak için uygulanan fibrinojen konsantrelerinin etkisi tartışmalıdır. Koroner arter baypas greftleme operasyonlarında (KABG) kardiyopulmoner baypas (KPB) sonrası uygulanan fibrinojen infüzyonunun postoperatif kanama üzerine etkisini sunmayı amaçladık.
GEREÇ VE YÖNTEM: Çalışmaya, KABG yapılan ve fibrinojen düzeyleri KPB sonrası 2.5 g/L altında ölçülen 67 hasta dahil edildi. Fibrinojen konsantresi verilen 32 hastanın (Grup F; n=32 hasta) verileri, fibrinojen konsantresi verilmeyen 35 hastanın verileri ile (Grup NF; n=35 hasta) karşılaştırıldı.
BULGULAR: KPB sonrası fibrinojen düzeylerini 2,5 g/L ve üzerine çıkarmak için hastalara fibrinojen konsantresi uygulandı. KPB sonrası fibrinojen seviyeleri, her iki grup için preoperatif seviyelere göre anlamlı olarak azaldı (p<0.01), ancak azalma oranı açısından gruplar arasında fark yoktu (p=0.321). Grup F'deki hastalara 2,94±0,91 g fibrinojen uygulandı. Gruplar arası postoperatif drenaj hem 0-12 saat (p=0,142) hem de 12-24 saat (p=0,309) arasında anlamlı değildi.
SONUÇ: Fibrinojen konsantresi, düşük plazma fibrinojen düzeylerini artıran ikincil etkilerle postoperatif drenaj miktarını azaltabilir ve pıhtılaşma fizyolojisinin düzelmesine katkıda bulunabilir. Ancak bu azalma istatistiksel olarak anlamlı olmadığı için fibrinojen konsantrelerinin sadece kanama riski yüksek hastalarda ve KPB sonrası fibrinojen düzeyi <1.5 g/L'nin altında olan hastalarda kullanılması gerektiğini düşünüyoruz.

Keywords

Fibrinojen, Koroner arter baypas cerrahisi, Postoperatif kanama

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