Surgery Clinical Trial
Official title:
The Effects of Fibrinogen Concentrate Infusion on Perioperative Blood Loss and Allogeneic Blood Conservation in Patients Undergoing Scoliosis Surgery
Allogeneic blood products transfusions are often necessary to treat perioperative bleeding in patients undergoing complex scoliosis surgeries. A prospective, randomized trial is designed to evaluate if the infusion of fibrinogen concentrate may reduce allogeneic blood transfusion in patients undergoing scoliosis surgery. Eligible patients will be randomly assigned to treatment group (fibrinogen concentrate infusion) and control group (normal saline infusion), and functional fibrinogen will be measured to guide the infusion of fibrinogen concentrate. Perioperative blood loss, intraoperative blood loss, and the amount of perioperative allogeneic blood transfusion will be compared between the two groups to determine the effect of fibrinogen concentrate infusion.
This is a prospective, randomized, double-blinded, placebo controlled trial to evaluate the
effects of fibrinogen concentrate infusion on perioperative blood loss and the amount of
perioperative allogeneic blood transfusion in patients undergoing scoliosis surgery.
Recently, the inherent risks of blood, along with the continued rise in blood costs,
activated the development and use of alternatives to blood transfusion. Fibrinogen
concentrate may limit postoperative bleeding and lead to a significant reduction in
allogeneic blood products transfusions in cardiac surgery and craniosynostosis surgery.
However, the effect of fibrinogen concentrate in scoliosis surgery is still uncertain.
Therefore, a prospective, randomized trial is designed to evaluate if the infusion of
fibrinogen concentrate may reduce allogeneic blood transfusion in patients undergoing
scoliosis surgery.
Patients older than 12y/o with adolescent idiopathic scoliosis planed for elective posterior
scoliosis correction surgery will be enrolled for this study after informed consent. Patients
will be randomly assigned to a treatment group or a control group. Functional fibrinogen will
be measured using TEG 5000 (Haemoscope Corp, IL, USA) at the start of surgery and the results
of FLEV and MA will be recorded. After pedicle screw placement, a second functional
fibrinogen will be measured and the patients in treatment group will receive fibrinogen
concentrate (FIBRORAAS, Shanghai RAAS Blood Products Co, Ltd, Shanghai, China) 30mg kg-1. For
safety concern, the maximum fibrinogen concentrate administration for each individual shall
not exceed either 2g. Patients in the control group will receive placebo treatment with
normal saline. After 15 minutes from fibrinogen concentrate or placebo administration, a
third functional fibrinogen measurement will be performed to assess the effect of treatment.
The following treatment will be guaranteed by the standard protocol in the presence of
ongoing bleeding.
Data includes all the demographics, preoperative conditions, procedure details,
intraoperative data, and outcome measurements will be recorded. Additional data including
FLEV and MA value, as well as fibrinogen values both preoperatively and at the arrival at
wards. The primary endpoint of this study will be the total perioperative blood loss, and
secondary endpoints will include: perioperative blood loss per fused level, intraoperative
blood loss per fused level, the amount of postoperative drainage, the amount of postoperative
drainage per fused level, total units of perioperative allogeneic pRBCs transfused, total
volume of FFP transfused, total PLT units transfused. Safety endpoints will include operative
mortality and perioperative thromboembolic complications.
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