Fibrinogen Concentration Significantly Decreases After On-Pump Versus Off-Pump Coronary Artery Bypass Surgery: A Systematic Point-of-Care ROTEM Analysis

ObjectivesStudies have emphasized the importance of normal fibrinogen concentrations in surgical patients. The primary hypothesis of this study was that fibrinogen levels significantly decrease in on-pump coronary artery bypass graft (CABG) surgery versus off-pump coronary artery bypass graft (OPCAB) surgery. The second objective was to show that ROTEM (TEM International, GmbH, Munich, Germany) rapidly detects these abnormalities compared with standard tests.DesignA prospective, nonrandomized study.SettingA university hospital.ParticipantsForty-two and 62 patients in the CABG and OPCAB groups, respectively, undergoing first-time bypass surgery were included.InterventionsCABG versus OPCAB surgery.Measurements and Main ResultsRoutine coagulation tests and ROTEM values were measured before anesthesia (T0), after the first dose of heparin (T1), after protamine (T2), upon intensive care unit arrival (T3), and 4 hours postoperatively (T4). The outcome measures were followed until 4 hours postoperatively. Fibrinogen concentrations were significantly lower in the CABG versus the OPCAB group at T2 (170 ± 44 v 243 ± 73 mg/dL, p < 0.001) and T3 (179 ± 42 v 232 ± 68 mg/dL, p < 0.001). This was confirmed by significantly lower FIBTEM maximal clot firmness values at T2 (9 ± 4 v 14 ± 5 mm, p < 0.001) and T3 (9 ± 4 v 13 ± 6 mm, p < 0.001). In the CABG group, patients received significantly more transfusions of all blood products except fresh frozen plasma.ConclusionsFibrinogen concentration significantly decreases after cardiopulmonary bypass. ROTEM helps in its fast detection.