‘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;51:1695-1706
Critical appraisalCritical appraisal
Peerachatra Mangmeesri, Thassayu Yuyen and Benno von BormannAugust 20. 2013
Purpose: Comparing
Fibrinogen concentration analysis (Clauss)
Conductivity Viscosity
Fibrin clot firmness (FIBTEM*)*Platelet Inhibition!
Rotem™, Tem International,Munich (GER)
Note!FIBTEM does not analyze the total clotting capacity
Consecutive Patients (09.2006 – 06.2007)
Cardiac Surgery: ‘Diffuse bleeding’ after ECC (n = 33)
CSL Behring, Marburg (GER)
Fibrinogen concentrate6 g (mean)
4 – 13 g (range)
Hemostyptics – All (33)
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
Therapeutic measures - Effect
ClinicBlood loss – not mentioned
Hemodynamics – not mentioned
Transfusion (units)1 PRC: one patient
2 PRC, 6 FFP, 3 Plts: one patient
von Bormann B, Suksompong S, Zander R: ‘Therapy with fibrinogen concentrate: clinical and ethical
considerations’. TRANSFUSION 2013;53:1137-1138
(Comment on Solomon C et al. TRANSFUSION 2011;51:1695)
German Guidelines 2006/07“After Fibrinogen therapy the fibrinogen concentration
should be above 100 mg/dL”
Fibrinogen (mg/dL)(mean) 4 methods
Pre: 185 ± 55 Post: 350 ± 70
Salomon et al.
Discussion Fibrinogen Concentrate – missing issues
Side effectsAnaphylaxis, thromboembolism, viral transmission
Costs1 g Fibrinogen concentrate ≈ 6,000.- Baht
Conflict of interestFive* out of eight
*SponsorsCSL Behring, Marburg, GER (Fibrinogen concentrate)
Tem International, Munich, GER (Rotem™)
