Evaluation of fibrinogen function by CFF-A10 in cardiac surgery
1Department of Anesthesiology, Toyama Prefectural Central Hospital, 930-8550 Toyama, Japan
2Department of Anesthesiology, Toyama University Hospital, 930-0194 Toyama, Japan
3Department of Anesthesiology, Toyama Nishi General Hospital, 939-2716 Toyama, Japan
DOI: 10.22514/sv.2023.072 Vol.19,Issue 6,November 2023 pp.52-59
Submitted: 03 January 2023 Accepted: 14 February 2023
Published: 08 November 2023
Fibrinogen function is evaluated as the maximum amplitude (MA) of the citrated functional fibrinogen (CFF) assay in TEG6s®, however, CFF-MA requires a long time to obtain results. CFF-A10 (10-minute value), allowing more rapid decisions, however, no studies have evaluated the correlation between CFF-A10 levels and fibrinogen concentration. This study aimed to assess the correlation between CFF-A10 and blood fibrinogen levels measured using the dry hematology method after cardiopulmonary bypass (CPB). This retrospective study was conducted in a single university hospital and enrolled 192 patients of all ages who underwent cardiovascular surgery with CPB between 01 March 2020, and 05 November 2021. CFF-A10 and CFF-MA levels were measured using the TEG6s® global hemostasis assay, and blood fibrinogen levels were measured using the Fibcare® DRIHEMATO Fib-HSII after CPB. Simple linear regression analysis was used to evaluate the relationship between TEG6s® parameters and fibrinogen concentration. Furthermore, the patients were classified into four groups based on the cut-off values of fibrinogen at 150 mg/dL and CFF-A10, and the background factors for each group were analyzed. CFF-A10 and blood fibrinogen levels were correlated by linear regression (p < 0.0001, R2 = 0.37), similar to CFF-MA and fibrinogen levels (p < 0.0001, R2 = 0.40). The optimal cut-off value, which maximizes the sensitivity and specificity, of CFF-A10 for predicting low fibrinogen levels below 150 mg/dL, was 8.4 mm, with a sensitivity of 80.7% and specificity of 67.9%; that of CFF-MA was 9.2 mm, with a sensitivity of 76.3% and specificity of 69.8%. Despite sufficient blood fibrinogen levels, patients with low CFF-A10 levels experienced more postoperative bleeding. CFF-A10 predicted fibrinogen loss faster and with the same accuracy as CFF-MA did. Low CFF-A10 levels, despite sufficient fibrinogen levels, may be associated with increased blood loss following CPB.
CFF-A10; CFF-MA; Fibrinogen; Hemostasis; Thromboelastometory
Minako Furuta,Hisakatsu Ito,Shota Sakai,Daisuke Hibi,Mitsuaki Yamazaki. Evaluation of fibrinogen function by CFF-A10 in cardiac surgery. Signa Vitae. 2023. 19(6);52-59.
 Zhang Y, Qiu Y, Blanchard AT, Chang Y, Brockman JM, Ma VP, et al. Platelet integrins exhibit anisotropic mechanosensing and harness piconewton forces to mediate platelet aggregation. Proceedings of the National Academy of Sciences of the United States of America. 2018; 115: 325–330.
 Franchini M, Lippi G. Fibrinogen replacement therapy: a critical review of the literature. Blood Transfusion. 2012; 10: 23–27.
 Duvernay MT, Temple KJ, Maeng JG, Blobaum AL, Stauffer SR, Lindsley CW, et al. Contributions of protease-activated receptors PAR1 and PAR4 to thrombin-induced GPIIbIIIa activation in human platelets. Molecular Pharmacology. 2017; 91: 39–47.
 Hensley NB, Mazzeffi MA. Pro-con debate: fibrinogen concentrate or cryoprecipitate for treatment of acquired hypofibrinogenemia in cardiac surgical patients. Anesthesia & Analgesia. 2021; 133: 19–28.
 Lang T, Johanning K, Metzler H, Piepenbrock S, Solomon C, Rahe-Meyer N, et al. The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia. Anesthesia & Analgesia. 2009; 108: 751–758.
 Karkouti K, Callum J, Crowther MA, McCluskey S.A, Pendergrast J, Tait G, et al. The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesthesia & Analgesia. 2013; 117: 14–22.
 Tibi P, McClure RS, Huang J, Baker RA, Fitzgerald D, Mazer CD, et al. STS/SCA/AmSECT/SABM update to the clinical practice guidelines on patient blood management. The Annals of Thoracic Surgery. 2021; 112: 981–1004.
 Kozek-Langenecker SA, Ahmed AB, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, et al. Management of severe perioperative bleeding. European Journal of Anaesthesiology. 2017; 34: 332–395.
 Faraoni D, Meier J, New HV, Van der Linden PJ, Hunt BJ. Patient blood management for neonates and children undergoing cardiac surgery: 2019 NATA guidelines. Journal of Cardiothoracic and Vascular Anesthesia. 2019; 33: 3249–3263.
 Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2018; 32: 88–120.
 Huang J, Firestone S, Moffatt-Bruce S, Tibi P, Shore-Lesserson L. 2021 clinical practice guidelines for anesthesiologists on patient blood management in cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2021; 35: 3493–3495.
 Magunia H, Azizy E, Krautter L, Rosenberger P, Straub A. Detection of hypofibrinogenemia during cardiac surgery: a comparison of resonance-based thrombelastography with the traditional Clauss method. Blood Coagulation & Fibrinolysis. 2020; 31: 551–557.
 Erdoes G, Schloer H, Eberle B, Nagler M. Next generation viscoelasticity assays in cardiothoracic surgery: feasibility of the TEG6s system. PLoS One. 2018; 13: 1–11.
 Kawashima S, Suzuki Y, Sato T, Kikura M, Katoh T, Sato S. Four-group classification based on fibrinogen level and fibrin polymerization associated with postoperative bleeding in cardiac surgery. Clinical and Applied Thrombosis/Hemostasis. 2016; 22: 648–655.
 Brown AC, Hannan RH, Timmins LH, Fernandez JD, Barker TH, Guzzetta NA. Fibrin network changes in neonates after cardiopulmonary bypass. Anesthesiology. 2016; 124: 1021–1031.
 Nellenbach K, Guzzetta NA, Brown AC. Analysis of the structural and mechanical effects of procoagulant agents on neonatal fibrin networks following cardiopulmonary bypass. Journal of Thrombosis and Haemostasis. 2018; 16: 2159–2167.
 Cui Y, Hei F, Long C, Feng Z, Zhao J, Yan F, et al. Perioperative monitoring of thromboelastograph on hemostasis and therapy for cyanotic infants undergoing complex cardiac surgery. Artificial Organs. 2009; 33: 909–914.
 Gertler R, Andropoulos DB. Cardiopulmonary bypass. Anesthesia for congenital heart disease (pp.126–155). 3rd ed. Wiley-Blackwell: Hoboken. 2015.
 Ogawa S, Tanaka KA, Nakajima Y, Nakayama Y, Takeshita J, Arai M, et al. Fibrinogen measurements in plasma and whole blood. Anesthesia & Analgesia. 2015; 120: 18–25.
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