Standard vs. point-of-care measurement of fibrinogen: potential impact on clinical decisions

Abstract

Background: Intraoperative major bleeding is a common complication during surgery and can lead to the transfusion of blood products and/or procoagulant drugs. This is a therapeutic challenge, and adherence to guidelines is desirable to preserve blood product resources. The intraoperative administration of fibrinogen concentrate, a pro-coagulant drug, in bleeding patients might reduce the use and therefore the risks associated with blood products.

Methods: In this observational pilot study we determined whether fibrinogen measured by point-of-care thromboelastometry (Rotem®, fibtem-test) would lead to a similar therapeutical decision concerning the administration of fibrinogen concentrate when compared to the standard method (Clauss).

Results: Blood samples of 36 patients undergoing major surgery were simultaneously analyzed using both methods. According to the cutoff values of current guidelines based on the standard method, no patient would receive fibrinogen concentrate. In comparison, if point-of-care thromboelastometry were used and its cutoff for fibrinogen applied, 16 patients (44%, P<0.001) would receive fibrinogen concentrate.

Conclusion: The method used for intraoperative coagulation monitoring has a major impact on therapeutic decisions concerning the use of blood products and/or pro-coagulant drugs. If fibrinogen was measured by point-of-care thromboelastometry instead of the standard method according to Clauss, the use of fibrinogen concentrate would increase significantly and less fresh frozen plasma would be administered.