Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study.
Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study.
复制标题
DOI：
10.1093/bja/aep089
复制
发表时间：
2009-06
影响因子：
9.8
通讯作者：
Tanaka KA
中科院分区：
文献类型：
--
作者：
Rahe-Meyer N;Pichlmaier M;Haverich A;Solomon C;Winterhalter M;Piepenbrock S;Tanaka KA
主动脉瓣手术和升主动脉置换术（AV-AA）后的出血素质可通过新鲜冰冻血浆（FFP）和浓缩血小板进行控制。目的是比较传统输血管理和 FIBTEM（血栓弹力测试）引导的纤维蛋白原浓缩液给药的止血效果。使用 42 名选择性患者（A 组）的回顾性数据开发了血液制品输注算法。体外循环后输注2单位浓缩血小板，如果持续出血，如果拆除主动脉夹时血小板计数≤100×103 µl−1，则输注4 u FFP，如果血小板计数> 100×103 µl−1，则反之亦然。每个治疗步骤的触发条件是 5 分钟内用干拭子从纵隔伤口区域吸收 ≥60 g 血液。分配到两个前瞻性组既不是随机的也不是盲法的； B 组 (n=5) 根据算法进行治疗，C 组 (n=10) 在基于算法的治疗前接受纤维蛋白原浓缩物（Haemocomplettan® P/Riastap，CSL Behring，马尔堡，德国）。平均 5.7 (0.7) g 纤维蛋白原浓缩物将所有 C 组患者的失血量降低至输血触发水平以下。 C组减少了输血[平均0.7（范围0-4）u vs A组8.5（5.3）和B组8.2（2.3）]并减少术后出血[366（199）ml vs A组793（560）ml和B组716（219）ml]。在这项初步研究中，FIBTEM 引导的纤维蛋白原浓缩物给药与接受 AV-AA 的患者输血需求减少和术后 24 小时出血有关。
Bleeding diathesis after aortic valve operation and ascending aorta replacement (AV–AA) is managed with fresh-frozen plasma (FFP) and platelet concentrates. The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration. A blood products transfusion algorithm was developed using retrospective data from 42 elective patients (Group A). Two units of platelet concentrate were transfused after cardiopulmonary bypass, followed by 4 u of FFP if bleeding persisted, if platelet count was ≤100×103 µl−1 when removing the aortic clamp, and vice versa if platelet count was >100×103 µl−1. The trigger for each therapy step was ≥60 g blood absorbed from the mediastinal wound area by dry swabs in 5 min. Assignment to two prospective groups was neither randomized nor blinded; Group B (n=5) was treated according to the algorithm, Group C (n=10) received fibrinogen concentrate (Haemocomplettan® P/Riastap, CSL Behring, Marburg, Germany) before the algorithm-based therapy. A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients. Group C had reduced transfusion [mean 0.7 (range 0–4) u vs 8.5 (5.3) in Group A and 8.2 (2.3) in Group B] and reduced postoperative bleeding [366 (199) ml vs 793 (560) in Group A and 716 (219) in Group B]. In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV–AA.
登录
查看更多内容
影响因子：
0.3
作者：
JOHAR, RS;SMITH, RP
通讯作者：
SMITH, RP
影响因子：
7.5
作者：
ELODI, S;VARADI, K
通讯作者：
VARADI, K
影响因子：
20.3
作者：
KESTIN, AS;VALERI, CR;MICHELSON, AD
通讯作者：
MICHELSON, AD
影响因子：
6.5
作者：
O'Shaughnessy, DF;Atterbury, C;Williamson, LM
通讯作者：
Williamson, LM
影响因子：
10.4
作者：
Charbit, B.;Mandelbrot, L.;De Prost, D.
通讯作者：
De Prost, D.