Impact of cardiopulmonary bypass duration on efficacy of fibrinogen replacement with cryoprecipitate compared with fibrinogen concentrate: a post hoc analysis of the Fibrinogen Replenishment in Surgery (FIBRES) randomised controlled trial

• DOI: 10.1016/j.bja.2022.05.012
• Publication Date: 2022-06-28T04:20:08Z
• Authors: Justyna Bartoszko; Selene Martinez-P...; Jeannie Callum; Keyvan Karkouti; Michael E. Farouh; Damon C. Scales; Nancy M. Heddle; Mark Crowther; Vivek Rao; Hans-Peter Hucke; Jo Carroll; Deep Grewal; Sukhpal Brar; Jean Brussières; Hilary Grocott; Christopher Harle; Katerina Pavenski; Antoine Rochon; Tarit Saha; Lois Shepherd; Summer Syed; Diem Tran; Daniel Wong; Michelle Zeller
• Keywords: Cryoprecipitate

BackgroundCoagulopathy in cardiac surgery is frequently associated with acquired hypofibrinogenaemia, which can be treated either purified fibrinogen concentrate (FC) or cryoprecipitate. Because the latter not and therefore contains additional coagulation factors, it thought to more effective for treatment of coagulopathy that occurs after prolonged cardiopulmonary bypass (CPB). We examined impact CPB duration on efficacy two therapies surgery.MethodsThis was a post hoc analysis Fibrinogen Replenishment Surgery (FIBRES) RCT comparing FC (4 g) cryoprecipitate (10 U) adult patients undergoing experiencing bleeding hypofibrinogenaemia (n=735). The primary outcome allogeneic blood products transfused within 24 h CPB. Subjects were stratified by (≤120, 121–180, >180 min). interaction assignment tested.ResultsSubjects longer experienced transfusion. With time ≤120 min (FC, n=134; cryoprecipitate, n=146), ratio least-squares means between groups total at 0.90 (one-sided 97.5% confidence interval [CI]: 0.00–1.12); P=0.004. For subjects 121–180 min, 1.00 ([one-sided CI: 0.00–1.22]; P=0.03], 0.91 0.00–1.12]; P=0.005). Results similar all secondary outcomes, no outcomes.ConclusionsThe haemostatic non-inferior irrespective surgery.Clinical trial registrationNCT03037424.