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Critical appraisal Peerachatra Mangmeesri, Thassayu Yuyen and Benno von Bormann August 20. 2013 ‘A comparison of fibrinogen measurement methods with fibrin.

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Presentation on theme: "Critical appraisal Peerachatra Mangmeesri, Thassayu Yuyen and Benno von Bormann August 20. 2013 ‘A comparison of fibrinogen measurement methods with fibrin."— Presentation transcript:

1 Critical appraisal Peerachatra Mangmeesri, Thassayu Yuyen and Benno von Bormann August ‘A comparison of fibrinogen measurement methods with fibrin clot elasticity assessed by thromboelastometry, before and after administration of fibrinogen concentrate in cardiac surgery patients.’ Solomon C et al. TRANSFUSION 2011;51:

2 Fibrinogen concentration analysis (Clauss)
Purpose: Comparing Fibrinogen concentration analysis (Clauss) Viscosity Conductivity

3 Fibrin clot firmness (FIBTEM*)
*Platelet Inhibition!

4 Rotem™, Tem International,
Munich (GER)

5

6

7 FIBTEM does not analyze the total clotting capacity
Note! FIBTEM does not analyze the total clotting capacity

8 Consecutive Patients (09.2006 – 06.2007)
Cardiac Surgery: ‘Diffuse bleeding’ after ECC (n = 33)

9 Fibrinogen concentrate 6 g (mean) 4 – 13 g (range)
Hemostyptics – All (33) Fibrinogen concentrate 6 g (mean) 4 – 13 g (range) CSL Behring, Marburg (GER)

10 Fb-C = Fibrinogen concentrate
Laboratory findings Parameter Pre Fb-C Post Fb-C FIBTEM (mm) 9.8 ± 3.6 20.5 ± 3.9 Fibrinogen (mg/dL) (mean) 4 methods 185 ± 55 350 ± 70 Platelet Count 92x109 ± 39x109 102x109 ± 40x109 Fb-C = Fibrinogen concentrate

11 Therapeutic measures - Effect
Clinic Blood loss – not mentioned Hemodynamics – not mentioned Transfusion (units) 1 PRC: one patient 2 PRC, 6 FFP, 3 Plts: one patient

12 von Bormann B, Suksompong S, Zander R:
‘Therapy with fibrinogen concentrate: clinical and ethical considerations’. TRANSFUSION 2013;53: (Comment on Solomon C et al. TRANSFUSION 2011;51:1695)

13

14 “After Fibrinogen therapy the fibrinogen concentration
German Guidelines 2006/07 “After Fibrinogen therapy the fibrinogen concentration should be above 100 mg/dL” Salomon et al. Fibrinogen (mg/dL) (mean) 4 methods Pre: 185 ± 55 Post: 350 ± 70

15 Discussion Side effects Costs
Fibrinogen Concentrate – missing issues Side effects Anaphylaxis, thromboembolism, viral transmission Costs 1 g Fibrinogen concentrate ≈ 6,000.- Baht

16 Conflict of interest Five* out of eight *Sponsors
CSL Behring, Marburg, GER (Fibrinogen concentrate) Tem International, Munich, GER (Rotem™)

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