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Master Thesis

Taux plasmatique de fibrinogène préopératoire et saignement sévère en chirurgie cardiaque sous circulation extracorporelle

Abstract : Background: an inverse linear relationship has been reported between preoperative fibrinogen level (PFL) and postoperative blood loss in cardiac surgery. However, high PFL have been associated with increased blood transfusion and reoperation. We tested the hypothesis that the relationship between PFL and severe perioperative bleeding exists but is not linear. Methods: after approval by our ethical committee, we reviewed retrospective data from on-pump cardiac surgery patients between september 2010 and may 2014 (n=3883). The perioperative severe bleeding was defined as a universal definition perioperative bleeding (UPDB) class 3 or 4. The relationship between PFL and perioperative severe bleeding was analysed by binary logistic regression. Spline transformation was used to identify critical PFL responsible for excessive bleeding. Results: severe bleeding defined by a UDPB class ≥ 3 was observed in 957 (24.6%) patients. A significant and U-shaped relationship was observed between PFL and excessive bleeding. The area under the ROC curve was 0.57 [95% CI (0.53-0.61)] and PFL cut-off level was 2.8 g/L. The negative predictive value for this threshold was 75%. We confirm previous results linking low PFL and severe bleeding, but also identify an increase in severe bleeding for high PFL in cardiac surgery. Conclusions: a U-shape relationship exists between PFL and the risk of severe perioperative bleeding. Patients with very low as well as very high PFL are both at risk of excessive bleeding after on-pump cardiac surgery.
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Submitted on : Tuesday, January 7, 2020 - 3:03:15 PM
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Stefano Mion-Viglino. Taux plasmatique de fibrinogène préopératoire et saignement sévère en chirurgie cardiaque sous circulation extracorporelle. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02430742⟩



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