Safety of Fibrinogen Concentrate and Cryoprecipitate in Cardiovascular Surgery: Multicenter Database Study

Takuma Maeda, Shigeki Miyata, Akihiko Usui, Kimitoshi Nishiwaki, Hitoshi Tanaka, Yutaka Okita, Nobuyuki Katori, Hideyuki Shimizu, Hiroaki Sasaki, Yoshihiko Ohnishi, Yuichi Ueda

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. Design: Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. Setting: Four hospitals (1 national cardiovascular center and 3 university hospitals). Participants: Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). Interventions: Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. Measurements and Main Results: Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score–matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95% confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95% confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. Conclusions: Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients.

Original languageEnglish
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Fibrinogen
Multicenter Studies
Databases
Safety
Propensity Score
Thoracic Surgery
Mortality
Multivariate Analysis
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Cardiopulmonary Bypass
Cohort Studies
Retrospective Studies
Incidence

Keywords

  • cardiovascular surgery
  • cryoprecipitate
  • fibrinogen
  • fibrinogen concentrate
  • massive bleeding

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Safety of Fibrinogen Concentrate and Cryoprecipitate in Cardiovascular Surgery : Multicenter Database Study. / Maeda, Takuma; Miyata, Shigeki; Usui, Akihiko; Nishiwaki, Kimitoshi; Tanaka, Hitoshi; Okita, Yutaka; Katori, Nobuyuki; Shimizu, Hideyuki; Sasaki, Hiroaki; Ohnishi, Yoshihiko; Ueda, Yuichi.

In: Journal of Cardiothoracic and Vascular Anesthesia, 01.01.2018.

Research output: Contribution to journalArticle

Maeda, Takuma ; Miyata, Shigeki ; Usui, Akihiko ; Nishiwaki, Kimitoshi ; Tanaka, Hitoshi ; Okita, Yutaka ; Katori, Nobuyuki ; Shimizu, Hideyuki ; Sasaki, Hiroaki ; Ohnishi, Yoshihiko ; Ueda, Yuichi. / Safety of Fibrinogen Concentrate and Cryoprecipitate in Cardiovascular Surgery : Multicenter Database Study. In: Journal of Cardiothoracic and Vascular Anesthesia. 2018.
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abstract = "Objectives: To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. Design: Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. Setting: Four hospitals (1 national cardiovascular center and 3 university hospitals). Participants: Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). Interventions: Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. Measurements and Main Results: Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score–matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95{\%} confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95{\%} confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. Conclusions: Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients.",
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T1 - Safety of Fibrinogen Concentrate and Cryoprecipitate in Cardiovascular Surgery

T2 - Multicenter Database Study

AU - Maeda, Takuma

AU - Miyata, Shigeki

AU - Usui, Akihiko

AU - Nishiwaki, Kimitoshi

AU - Tanaka, Hitoshi

AU - Okita, Yutaka

AU - Katori, Nobuyuki

AU - Shimizu, Hideyuki

AU - Sasaki, Hiroaki

AU - Ohnishi, Yoshihiko

AU - Ueda, Yuichi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. Design: Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. Setting: Four hospitals (1 national cardiovascular center and 3 university hospitals). Participants: Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). Interventions: Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. Measurements and Main Results: Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score–matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95% confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95% confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. Conclusions: Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients.

AB - Objectives: To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. Design: Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. Setting: Four hospitals (1 national cardiovascular center and 3 university hospitals). Participants: Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). Interventions: Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. Measurements and Main Results: Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score–matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95% confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95% confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. Conclusions: Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients.

KW - cardiovascular surgery

KW - cryoprecipitate

KW - fibrinogen

KW - fibrinogen concentrate

KW - massive bleeding

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