Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur J Vasc Endovasc Surg. 2021 May;61(5):799-808. doi: 10.1016/j.ejvs.2021.02.046. Epub 2021 Mar 24.
To determine the relationship between the value of fibrinogen assessed by the FIBTEM clot amplitude at 10 minutes (A10 FIBTEM) measured on admission to the intensive care unit (ICU) and the amount of drainage output at 24 hours, to investigate whether the A10 FIBTEM predicts severe bleeding (SB), and to define A10 FIBTEM thresholds to prevent (trigger) and treat (target) severe bleeding by fibrinogen supplementation.
In a single centre, retrospective observational study, 166 patients underwent elective open thoraco-abdominal aortic aneurysm (TAAA) repair between March 2016 and January 2019. Exclusion criteria were emergency, congenital, or acquired coagulopathy, or administration of PY inhibitor antiplatelet agents in the five days before surgery. All patients were managed intra-operatively and post-operatively according to a rotational thromboelastometry driven transfusion protocol. The principal endpoint was a composite outcome, which included bleeding, large volume transfusion, and re-operation.
FIBTEM clot amplitude after 10 minutes measured on ICU admission and post-operative bleeding at 24 hours showed an inverse linear relationship (R = .03; p = .026). Performance of A10 FIBTEM in predicting SB evaluated by Receiving Operating Curve analysis showed an area under the curve of 0.63 (95% CI 0.56 - 0.70; p = .026) with a best cutoff of 9 mm. An A10 FIBTEM of 3 mm was the cutoff associated with a positive predictive value of 50%, while an A10 FIBTEM of 9 mm showed a negative predictive value of 92%. On multivariable analysis, an A10 FIBTEM ≤ 3 mm remained independently associated with SB.
The present investigation shows for the first time in a population undergoing open TAAA repair that an A10 FIBTEM ≤ 3mm on ICU admission is associated with post-operative severe bleeding. Trigger and target values for fibrinogen supplementation, based on A10 FIBTEM, have been provided. The transferability and reliability of these cutoff values require further study.
确定入院时纤维蛋白原功能测定的 FIBTEM 凝血活酶时间 10 分钟（A10 FIBTEM）值与 24 小时引流量之间的关系，探讨 A10 FIBTEM 是否能预测严重出血（SB），并确定 A10 FIBTEM 阈值，以便通过纤维蛋白原补充来预防（触发）和治疗（目标）严重出血。
在单中心回顾性观察研究中，纳入 2016 年 3 月至 2019 年 1 月间择期行开放胸腹主动脉瘤（TAAA）修复术的 166 例患者。排除标准为急诊、先天性或获得性凝血功能障碍，或术前 5 天内使用 PY 抑制剂抗血小板药物。所有患者均根据旋转血栓弹性测定仪驱动的输血方案进行术中及术后管理。主要终点是一个复合结局，包括出血、大量输血和再次手术。
入院时 ICU 测量的 FIBTEM 凝血活酶时间 10 分钟后和术后 24 小时的出血量呈负线性关系（R=0.03；p=0.026）。通过接收者操作特征曲线分析评估 A10 FIBTEM 预测 SB 的性能，曲线下面积为 0.63（95%可信区间 0.56-0.70；p=0.026），最佳截断值为 9mm。A10 FIBTEM 为 3mm 时，阳性预测值为 50%，而 A10 FIBTEM 为 9mm 时，阴性预测值为 92%。多变量分析显示，A10 FIBTEM≤3mm 仍与 SB 独立相关。
本研究首次在接受开放 TAAA 修复术的人群中表明，入院时 ICU 测量的 A10 FIBTEM≤3mm 与术后严重出血相关。根据 A10 FIBTEM 提供了纤维蛋白原补充的触发和目标值。这些截断值的可转移性和可靠性需要进一步研究。
