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Meta-Analysis
. 2014 Mar;18(3):292-8.
doi: 10.1093/icvts/ivt506. Epub 2013 Dec 6.

The effects of pre- and postoperative fibrinogen levels on blood loss after cardiac surgery: a systematic review and meta-analysis

Chantal Gielen  1 , Olaf Dekkers, Theo Stijnen, Jan Schoones, Anneke Brand, Robert Klautz, Jeroen Eikenboom
Affiliations
Meta-Analysis

The effects of pre- and postoperative fibrinogen levels on blood loss after cardiac surgery: a systematic review and meta-analysis

Chantal Gielen et al. Interact Cardiovasc Thorac Surg. 2014 Mar.

Abstract

Objectives: Fibrinogen concentrate is increasingly used in cardiac surgery when bleeding is anticipated or ongoing. Since randomized clinical studies to support this are lacking, it is relevant to know whether lower fibrinogen levels are associated with excessive bleeding. We performed a systematic review and meta-analysis to define the association between fibrinogen levels and blood loss after cardiac surgery.

Methods: A database search (January 2013) was performed on publications assessing the association between pre- and postoperative fibrinogen levels and postoperative blood loss in adult patients undergoing cardiac surgery. Cohort studies and case-control studies were eligible for inclusion. The main outcome was the pooled correlation coefficient, calculated via Fisher's Z transformation scale, in a random-effects meta-analysis model stratified for the time point at which fibrinogen was measured.

Results: A total of 20 studies were included. The pooled correlation coefficient of studies (n = 9) concerning preoperative fibrinogen levels and postoperative blood loss was -0.40 (95% confidence interval: -0.58, -0.18), pointing towards more blood loss in patients with lower preoperative fibrinogen levels. Among papers (n = 16) reporting on postoperative fibrinogen levels and postoperative blood loss, the pooled correlation coefficient was -0.23 (95% confidence interval: -0.29, -0.16).

Conclusions: Our meta-analysis indicated a significant but weak-to-moderate correlation between pre- and postoperative fibrinogen levels and postoperative blood loss in cardiac surgery. This moderate association calls for appropriate clinical studies on whether fibrinogen supplementation will decrease postoperative blood loss.

Keywords: Blood loss; Cardiac surgery; Fibrinogen.

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Figures

Figure 1:
Figure 1:
Flow chart of study selection.
Figure 2:
Figure 2:
Meta-analysis of the correlation between preoperative fibrinogen and postoperative blood loss.
Figure 3:
Figure 3:
Meta-analysis of the correlation between postoperative fibrinogen and postoperative blood loss.
See this image and copyright information in PMC

Comment in

References

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