Effects of fibrinogen supplementation on clot formation in blood samples from cardiac surgery patients before and after tranexamic acid administration

• Published in: Transfusion medicine (Oxford, England) Vol. 29; no. 5; pp. 319 - 324
• Main Authors: Waldén, K., Shams Hakimi, C., Jeppsson, A., Karlsson, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2019
• Subjects: Aged; Anestesi och intensivvård; Anesthesiology and Intensive Care; Blood Coagulation - drug effects; Cardiac and Cardiovascular Systems; cardiac surgery; Cardiac Surgical Procedures; cardiopulmonary bypass; coagulopathy; Female; fibrinogen; Fibrinogen - administration & dosage; haemodilution; Humans; Kardiologi; Male; Middle Aged; Thrombelastography; tranexamic acid; Tranexamic Acid - administration & dosage; cardiopulmonary bypass; cardiac surgery; coagulopathy; fibrinogen; haemodilution; tranexamic acid
• ISSN: 0958-7578; 1365-3148
• DOI: 10.1111/tme.12604

Summary Objectives To investigate if supplementation with fibrinogen concentrate to blood samples collected after tranexamic acid administration improve clot formation more than what can be achieved with fibrinogen in the absence of tranexamic acid. Background It is not known if the combination of fibrinogen and tranexamic acid has additional effects than what can be achieved individually. Methods Four blood samples were collected from 15 coronary artery bypass patients. Two samples were collected before surgery, before and after 2 g tranexamic acid was administered. The preoperative samples were diluted to haematocrit 21%. Two samples were collected after surgery, before and after a second dose of 2 g tranexamic acid. Fibrinogen concentrate corresponding to a dose of 3 g in a 70‐kg patient was added to the samples. Platelet‐independent clotting time and maximum clot firmness assessed by thromboelastometry (ROTEM‐FIBTEM®) were compared between the samples. Results Administration of tranexamic acid shortened clotting time marginally (−6%) before surgery, P = 0·029) but did not influence clot firmness. Fibrinogen concentrate shortened clotting time (−14% before and −12% after surgery, both P = 0·003) and increased clot firmness (+51 and +39%, both P < 0·001). The effects of fibrinogen did not differ before and after tranexamic acid administration. Fibrinolysis was not detected in any sample. Conclusions The results of this in vitro study suggest that the enhancing effects of fibrinogen on clot firmness in blood samples from cardiac surgery patients are not further increased in the presence of tranexamic acid. Further studies on patients with ongoing bleeding and/or hyperfibrinolysis are necessary to validate the results.