Author: Downey LA et al.
Anesthesia & Analgesia 141(2): 240-251. doi:10.1213/ANE.0000000000007123
This randomized trial compared fibrinogen concentrate (RiaSTAP) with cryoprecipitate for fibrinogen replacement in neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB). Thirty-six neonates were randomized, with 13 in the cryoprecipitate group and 17 in the fibrinogen concentrate group completing the protocol. The primary endpoint—percent change in ex vivo clot degradation from baseline at 24 hours—showed faster degradation in the fibrinogen group compared to cryoprecipitate.
Despite this, fibrinogen recipients required significantly less median post-CPB transfusion volume than the cryoprecipitate group (27.2 mL/kg vs 41.6 mL/kg in the intent-to-treat analysis). There were no differences in bleeding or thrombotic events between groups.
The study concludes that fibrinogen concentrate provides effective hemostatic restoration, reduces transfusion needs, and does not increase the risk of bleeding or thrombosis in neonates after CPB.
KEY POINTS
- Question: When compared to cryoprecipitate, can fibrinogen concentrate adequately restore hemostasis and reduce postoperative thrombosis risk in neonates undergoing cardiac during with cardiopulmonary bypass (CPB)?
- Findings: Patients who received fibrinogen concentrate CPB had similar ex vivo clot degradation rates throughout the immediate perioperative period with greater degradation at 24 hours postoperatively and received less post-CPB blood products with no increased risk of bleeding or thrombotic complications when compared to patients who received cryoprecipitate.
- Meaning: Given the increased risks associated with allogenic blood transfusions, our results suggest that fibrinogen concentrate may be a suitable alternative to achieve perioperative hemostasis in neonates undergoing cardiac surgery without increased risk of thrombotic or bleeding complications.
References
-
Downey LA, Moiseiwitsch N, Nellenbach K, et al. Anesth Analg. 2025;141:240–251. doi:10.1213/ANE.0000000000007123.
Thank you to Anesthesia & Analgesia for providing this important clinical trial data on fibrinogen replacement in neonatal cardiac surgery.