Abstract
Purpose: We observed whether the coagulation function improved and the bleeding tendency was controlled by fibrinogen concentrates or not. We thus evaluated their usefulness in treating patients with hypofibrinogenemia during thoracic aortic surgery. Methods: In 32 patients with hypofibrinogenemia under 150 mg/dl during either thoracic or thoracoabdominal aortic surgery, the blood coagulation ability was observed by ROTEM sigma and the 3-minute bleeding amount was measured during surgery. Results: The blood fibrinogen levels decreased to 109±26 mg/dl at the end of cardiopulmonary bypass, but they significantly increased to an average of 231±38 mg/dl after fibrinogen concentrates administration (p＜0.0001). The average 3-minute bleeding amount was 144±88 ml after heparin neutralization, but it significantly decreased to 85±74 ml after fibrinogen concentrates administration (p=0.0001). However, the 3-minute bleeding amount actually increased in 6 cases, while 26 cases (82%) showed a decrease in the bleeding amount. Fibtem A10 was extremely low at 4.8±2.7 mm after heparin neutralization, but the value increased to 14.1±4.1 mm after fibrinogen concentrates administration, thereby exceeding the value observed at the start of surgery (p＜0.0001). Extem A10, which reflects the extrinsic coagulation ability, and INTEM A10, which reflects the intrinsic coagulation ability, were both low at 31.3±11.0 mm and 30.9±10.7 mm, respectively, after heparin neutralization, but they significantly increased to 42.2±8.9 mm and 39.1±8.7 mm (p＜0.0001), respectively, after fibrinogen concentrates administration. There were no operative deaths among the 32 cases, but there were three cases in which thromboembolism could not be ruled out. Two of them had myocardial infarction, which had been caused by the occlusion of the reconstructed right coronary artery, while the other case suffered from a new cerebral infarction after undergoing aortic arch replacement, but the relationship between these events and fibrinogen concentrates administration could not be clarified. Conclusion: The administration of fibrinogen concentrates rapidly increased the blood fibrinogen levels and reduced bleeding. In addition, significant improvements in the extrinsic and intrinsic coagulation abilities were observed after fibrinogen concentrates administration.
