(497) Optimizing Perioperative Hemostasis: Assessing Fibrinogen Use in Cardiovascular/Transplant Surgeries

Introduction: Perioperative bleeding is a significant complication in cardiovascular (CV) and transplant surgeries, leading to increased morbidity and mortality. Human fibrinogen concentrate (HFC), has been used to manage such bleeding events. This study aims to assess the utilization, efficacy, safety, and financial impact of HFC at the University of Minnesota Medical Center (UMMC). We hypothesize that HFC improves perioperative hemostasis in these surgical populations.

Methods: A retrospective chart review was conducted for all patients who received HFC at UMMC from January 1, 2023, to December 31, 2023. Data collection included HFC administration details, demographics, fibrinogen levels, coagulation lab results including viscoelastic hemostasis testing, and type of surgery. The study evaluated usage, dosages, timing relative to lab results, and protocol adherence. Additionally, the concurrent use of other blood products and financial implications were analyzed to identify gaps in practice.

Results: A total of 550 HFC administrations were recorded in 261 patients, mainly in CV surgeries (40.5%) and liver transplants (33.2%). Pre-administration fibrinogen levels were low ( < 200 mg/dL) in 58.2% of cases, with a 32% average increase post-administration, indicating improved coagulation status. The average fibrin contribution to clot stiffness (FCS) increased from 1.48 hPa to 1.65 hPa post-administration. Despite protocol recommendations, 47.5% of HFC doses were given without meeting the FCS < 1.4 hPa criterion, suggesting variability in clinical decision-making. Post-administration, there was notable concurrent use of other blood products, including cryoprecipitate (24.1%) and packed red blood cells (39.8%), indicating a comprehensive approach to managing perioperative bleeding.

Conclusions: HFC administration effectively increased fibrinogen levels and improved clot stability in perioperative settings at UMMC. However, significant variability in administration timing and protocol adherence was observed, highlighting the need for standardized guidelines. Further interdisciplinary efforts are recommended to refine these guidelines, aiming to enhance patient hemostasis outcomes and resource utilization in perioperative hemostasis management.