PMID- 37588266
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230818
IS  - 2772-6096 (Electronic)
IS  - 2772-6096 (Linking)
VI  - 2
DP  - 2022 Jun
TI  - Weight-adjusted dosing of fibrinogen concentrate and cryoprecipitate in the 
      treatment of hypofibrinogenaemic bleeding adult cardiac surgical patients: a post 
      hoc analysis of the Fibrinogen Replenishment in cardiac surgery randomised 
      controlled trial.
PG  - 100016
LID - 10.1016/j.bjao.2022.100016 [doi]
LID - 100016
AB  - BACKGROUND: Hypofibrinogenaemia is associated with excessive bleeding after 
      cardiac surgery. Our aim was to compare the efficacy and safety of 
      weight-adjusted vs empiric dosing of fibrinogen replacement in cardiac surgery. 
      METHODS: In the Fibrinogen Replenishment in Cardiac Surgery (FIBRES) RCT, 
      patients (n=735) received fibrinogen concentrate (4 g) or cryoprecipitate (10 
      units). In this post-hoc analysis, patients were grouped into quartiles based on 
      increasing weight-adjusted dosing. Generalised estimating equations were used to 
      account for hospital site, age, sex, surgical complexity, urgency, and critical 
      preoperative status. The primary outcome was the number of units of red blood 
      cells transfused within 24 h of cardiopulmonary bypass. Secondary outcomes 
      included allogeneic blood components within 24 h, tamponade or major bleeding, 
      and thromboembolic complications, ischaemic complications, or both within 28 days 
      of cardiopulmonary bypass. RESULTS: The median weight-adjusted doses were 52 mg 
      kg(-1) of fibrinogen concentrate (inter-quartile range [IQR], 45-61; n=372) and 
      1.30 units per 10 kg of cryoprecipitate (IQR, 1.11-1.54; n=363). When patients 
      were divided into quartiles of lowest to highest weight-adjusted dosing, no 
      differences were seen in the primary outcome of red blood cell units transfused 
      within 24 h of cardiopulmonary bypass between the lowest and highest quartiles in 
      either the fibrinogen group (adjusted relative risk [RR]=0.90; 95% confidence 
      interval [CI], 0.71-1.13; P=0.36) or the cryoprecipitate group (adjusted RR=1.04; 
      95% CI, 0.76-1.43; P=0.80). Results were similar for all secondary outcomes. 
      CONCLUSION: Outcomes for the lowest and highest weight-adjusted doses of 
      fibrinogen replacement were comparable. Weight-adjusted dosing does not appear to 
      offer advantages over empiric dosing in this context. CLINICAL TRIAL 
      REGISTRATION: NCT03037424.
CI  - (c) 2022 The Authors.
FAU - Devine, Cian
AU  - Devine C
AD  - Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, 
      Canada.
FAU - Bartoszko, Justyna
AU  - Bartoszko J
AD  - Department of Anesthesia and Pain Management, Sinai Health System, Women's 
      College Hospital, University Health Network, University of Toronto, Toronto, 
      Ontario, Canada.
AD  - Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, 
      University Health Network, Toronto, Ontario, Canada.
AD  - Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, 
      University of Toronto, Toronto, Ontario, Canada.
FAU - Callum, Jeannie
AU  - Callum J
AD  - Department of Pathology and Molecular Medicine, School of Medicine, Queen's 
      University, Kingston, Ontario, Canada.
AD  - Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, 
      Kingston, Ontario, Canada.
FAU - Karkouti, Keyvan
AU  - Karkouti K
AD  - Department of Anesthesia and Pain Management, Sinai Health System, Women's 
      College Hospital, University Health Network, University of Toronto, Toronto, 
      Ontario, Canada.
AD  - Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, 
      University Health Network, Toronto, Ontario, Canada.
AD  - Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, 
      University of Toronto, Toronto, Ontario, Canada.
CN  - FIBRES Study Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT03037424
PT  - Journal Article
DEP - 20220609
PL  - England
TA  - BJA Open
JT  - BJA open
JID - 9918419157906676
PMC - PMC10430806
OTO - NOTNLM
OT  - cardiac surgery
OT  - coagulopathy
OT  - fibrinogen
OT  - haemostasis
OT  - transfusion
EDAT- 2022/06/09 00:00
MHDA- 2022/06/09 00:01
PMCR- 2022/06/09
CRDT- 2023/08/17 04:12
PHST- 2021/12/21 00:00 [received]
PHST- 2022/04/27 00:00 [accepted]
PHST- 2022/06/09 00:01 [medline]
PHST- 2022/06/09 00:00 [pubmed]
PHST- 2023/08/17 04:12 [entrez]
PHST- 2022/06/09 00:00 [pmc-release]
AID - S2772-6096(22)00015-6 [pii]
AID - 100016 [pii]
AID - 10.1016/j.bjao.2022.100016 [doi]
PST - epublish
SO  - BJA Open. 2022 Jun 9;2:100016. doi: 10.1016/j.bjao.2022.100016. eCollection 2022 
      Jun.