Fibrinogen Recovery and Changes in Fibrin-Based Clot Firmness after Cryoprecipitate Administration in Patients Undergoing Aortic Surgery Involving Deep Hypothermic Circulatory Arrest

BACKGROUND:

Cryoprecipitate may be used to treat bleeding in cardiac surgery. Its effects on plasma fibrinogen and fibrin clotting in this setting are poorly defined.

STUDY DESIGN AND METHODS:

Patients undergoing on-pump aortic surgery with deep hypothermic circulatory arrest (DHCA) were recruited prospectively. After protamine reversal, cryoprecipitate was administered to patients with bleeding, and fibrin deficit was indicated by thromboelastometry (ROTEM)-based FIBTEM test. Coagulation was assessed using ROTEM-based tests and standard laboratory tests before and after cryoprecipitate.

RESULTS:

Thirteen patients were included. Cryoprecipitate significantly elevated EXTEM A10 from (mean ± standard deviation) 29.4 ± 5.8 to 34.8 ± 5.9 mm (p = 0.01), FIBTEM A10 from 3.5 ± 0.9 to 5.8 ± 1.7 mm (p = 0.04), and plasma fibrinogen concentration from 154.2 ± 25.6 to 193.4 ± 30.5 mg/dL (p = 0.01). EXTEM clot elasticity at 10 minutes (CE10) increased from 42.5 ± 12.0 to 54.7 ± 14.9 mm after cryoprecipitate (30.0% increase). FIBTEM CE10 increased from 3.7 ± 0.9 to 6.2 ± 2.0 mm (53.0% increase). A fibrinogen dose of 13.2 ± 5.2 mg/kg was required to increase FIBTEM A10 by 1 mm. In vivo recovery of fibrinogen was 61.6 ± 31.2%.

CONCLUSIONS:

Cryoprecipitate increased plasma fibrinogen levels and fibrin-based clotting in bleeding patients undergoing aortic surgery with DHCA. In vivo recovery of fibrinogen was considerably below 100% and fibrinogen content varied between cryoprecipitate units. Trials are needed to assess whether cryoprecipitate impacts clinical outcomes and to evaluate its safety.