Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023

Introducción: La cirugía cardiaca con bypass cardiopulmonar es un procedimiento con alto riesgo de sangrado, requiere anticoagulación y puede inducir coagulopatía. El fibrinógeno experimenta una reducción crítica, para restaurar sus niveles, se pueden utilizar 4 gramos de concentrado de fibrinógeno...

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Fecha de publicación:
2023
Institución:
Universidad del Rosario
Repositorio:
Repositorio EdocUR - U. Rosario
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spa
OAI Identifier:
oai:repository.urosario.edu.co:10336/40193
Acceso en línea:
https://doi.org/10.48713/10336_40193
https://repository.urosario.edu.co/handle/10336/40193
Palabra clave:
Cirugía cardiaca
Bypass cardiopulmunar
Fibrinogeno
Crioprecipitados
Cardiac surgery
Cardiopulmonary bypass
Fibrinogen
Cryoprecipitates
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Attribution-NonCommercial-ShareAlike 4.0 International
id EDOCUR2_eb8296119f0dd9abbf88f59e316801ab
oai_identifier_str oai:repository.urosario.edu.co:10336/40193
network_acronym_str EDOCUR2
network_name_str Repositorio EdocUR - U. Rosario
repository_id_str
dc.title.none.fl_str_mv Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
dc.title.TranslatedTitle.none.fl_str_mv Fibrinogen doses administered by cryoprecipitates in cardiopulmonary bypass surgery in LaCardio-IC between 2020 and 2023
title Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
spellingShingle Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
Cirugía cardiaca
Bypass cardiopulmunar
Fibrinogeno
Crioprecipitados
Cardiac surgery
Cardiopulmonary bypass
Fibrinogen
Cryoprecipitates
title_short Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
title_full Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
title_fullStr Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
title_full_unstemmed Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
title_sort Dosis de fibrinógeno administrada mediante crioprecipitados en cirugía con bypass cardiopulmonar en LaCardio-IC entre 2020 y 2023
dc.contributor.advisor.none.fl_str_mv Montes, Félix Ramón
Patiño, Angélica María
Mantilla, Hugo Andrés
dc.subject.none.fl_str_mv Cirugía cardiaca
Bypass cardiopulmunar
Fibrinogeno
Crioprecipitados
topic Cirugía cardiaca
Bypass cardiopulmunar
Fibrinogeno
Crioprecipitados
Cardiac surgery
Cardiopulmonary bypass
Fibrinogen
Cryoprecipitates
dc.subject.keyword.none.fl_str_mv Cardiac surgery
Cardiopulmonary bypass
Fibrinogen
Cryoprecipitates
description Introducción: La cirugía cardiaca con bypass cardiopulmonar es un procedimiento con alto riesgo de sangrado, requiere anticoagulación y puede inducir coagulopatía. El fibrinógeno experimenta una reducción crítica, para restaurar sus niveles, se pueden utilizar 4 gramos de concentrado de fibrinógeno o crioprecipitados. En Colombia se usan crioprecipitados, la cantidad de fibrinógeno presente en cada unidad es variable, una característica intrínseca de estos. Objetivo: Determinar si la dosis de fibrinógeno administrada mediante crioprecipitados en el perioperatorio de cirugía con BCP en LaCardio-IC es menor a la sugerida actualmente. Metodología: Estudio observacional de cohorte retrospectiva. En adultos sometidos a cirugía con BCP en LaCardio-IC entre abril del 2020 y marzo de 2023 que recibieron crioprecipitados durante la cirugía o en las 48 horas siguientes a la intervención. Resultado: 1350 cirugías con BCP fueron realizadas en el periodo de estudio, 335 recibieron crioprecipitados. La primera dosis intraoperatoria fue de 1,1 unidades por cada 10 kg y 0,99 unidades por cada 10 kg de peso en el posoperatorio, lo cual es acorde con la literatura. Sin embargo; la cantidad media de fibrinógeno en la primera dosis intraoperatoria fue de 2399 mg y 3152 mg en la dosis total intraoperatoria fue de 3152 mg, menor a los 4 gr actualmente sugeridos (p < 0,05). Conclusión: La dosis de crioprecipitados en cirugía bypass cardiopulmonar en LaCardio-IC durante el periodo de estudio es acorde a la literatura actual, pero el fibrinógeno contenido en las unidades de crioprecipitados transfundidas es menor a la actualmente recomendada.
publishDate 2023
dc.date.accessioned.none.fl_str_mv 2023-07-18T12:28:06Z
dc.date.available.none.fl_str_mv 2023-07-18T12:28:06Z
dc.date.created.none.fl_str_mv 2023-07-17
dc.date.embargoEnd.none.fl_str_mv info:eu-repo/date/embargoEnd/2025-07-18
dc.type.none.fl_str_mv bachelorThesis
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.document.none.fl_str_mv Trabajo de grado
dc.type.spa.none.fl_str_mv Descriptivo observacional retrospectivo
dc.identifier.doi.none.fl_str_mv https://doi.org/10.48713/10336_40193
dc.identifier.uri.none.fl_str_mv https://repository.urosario.edu.co/handle/10336/40193
url https://doi.org/10.48713/10336_40193
https://repository.urosario.edu.co/handle/10336/40193
dc.language.iso.none.fl_str_mv spa
language spa
dc.rights.*.fl_str_mv Attribution-NonCommercial-ShareAlike 4.0 International
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_f1cf
dc.rights.acceso.none.fl_str_mv Restringido (Temporalmente bloqueado)
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-sa/4.0/
rights_invalid_str_mv Attribution-NonCommercial-ShareAlike 4.0 International
Restringido (Temporalmente bloqueado)
http://creativecommons.org/licenses/by-nc-sa/4.0/
http://purl.org/coar/access_right/c_f1cf
dc.format.extent.none.fl_str_mv 63
dc.format.mimetype.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidad del Rosario
dc.publisher.department.none.fl_str_mv Escuela de Medicina y Ciencias de la Salud
dc.publisher.program.none.fl_str_mv Especialización en Anestesiología FCI
publisher.none.fl_str_mv Universidad del Rosario
institution Universidad del Rosario
dc.source.bibliographicCitation.none.fl_str_mv Downey LA, Andrews J, Hedlin H, Kamra K, McKenzie ED, Hanley FL, Williams GD, Guzzetta NA. Fibrinogen Concentrate as an Alternative to Cryoprecipitate in a Postcardiopulmonary Transfusion Algorithm in Infants Undergoing Cardiac Surgery: A Prospective Randomized Controlled Trial. Anesth Analg. 2020 Mar;130(3):740-751.
Jahangirifard A, Razavi MR, Ahmadi ZH, Forozeshfard M. Effect of Desmopressin on the Amount of Bleeding and Transfusion Requirements in Patients Undergoing Heart Transplant Surgery. Basic Clin Pharmacol Toxicol. 2017 Sep;121(3):175-180.
Erdoes G, Koster A, Meesters MI, Ortmann E, Bolliger D, Baryshnikova E, Ahmed A, Lance MD, Ravn HB, Ranucci M, von Heymann C, Agarwal S. The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology. Anaesthesia. 2019 Dec;74(12):1589-1600.
Galas FR, de Almeida JP, Fukushima JT, Vincent JL, Osawa EA, Zeferino S, Câmara L, Guimarães VA, Jatene MB, Hajjar LA. Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: a randomized pilot trial. J Thorac Cardiovasc Surg. 2014 Oct;148(4):1647-55.
Hess AS, Hess JR, Coursin DB. Should Fibrinogen Concentrate Replace Cryoprecipitate in Cardiac Surgery? JAMA. 2019 Nov 26;322(20):1958-1960.
Desborough M, Sandu R, Brunskill SJ, Doree C, Trivella M, Montedori A, Abraha I, Stanworth S. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev. 2015 Jul 14;2015(7):CD007614.
Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: a systematic review. Anesth Analg. 2015 Apr;120(4):749-69
Warren OJ, Smith AJ, Alexiou C, Rogers PL, Jawad N, Vincent C, Darzi AW, Athanasiou T. The inflammatory response to cardiopulmonary bypass: part 1--mechanisms of pathogenesis. J Cardiothorac Vasc Anesth. 2009 Apr;23(2):223-31.
Callum J, Farkouh ME, Scales DC, Heddle NM, Crowther M, Rao V, Hucke HP, Carroll J, Grewal D, Brar S, Bussières J, Grocott H, Harle C, Pavenski K, Rochon A, Saha T, Shepherd L, Syed S, Tran D, Wong D, Zeller M, Karkouti K; FIBRES Research Group. Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood
Blasi A, Beltran J, Pereira A, Puig L. The cryoprecipitate: that old unknown. Rev Esp Anestesiol Reanim. 2015 Apr;62(4):204-12. English, Spanish.
Herrera Hernández AM, Ramírez Cerón CC, Vargas Rodríguez, J., Bermúdez MI, Beltrán Durán M. Grupo de Bancos de Sangre. Control de calidad de componentes sanguíneos. Documento técnico. 2011.
Droubatchevskaia N, Wong MP, Chipperfield KM, Wadsworth LD, Ferguson DJ. Guidelines for cryoprecipitate transfusion. British Columbia Medical Journal, 2007; 49(8), 441.
Dunbar NM, Olson NJ, Szczepiorkowski ZM, Martin ED, Tysarcyk RM, Triulzi DJ, Alarcon LH, Yazer MH. Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers. Transfusion. 2017 Jan;57(1):45-52.
Yazer MH, Dunbar NM, Cohn C, Dillon J, Eldib H, Jackson B, Kaufman R, Murphy MF, O’Brien K, Raval JS, Seheult J, Staves J, Waters JH; Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Blood product transfusion and wastage rates in obstetric hemorrhage. Transfusion. 2018 Jun;58(6):1408-1413.
Jiménez Orduz A. Descripción del abordaje transfusional frente al sangrado intraoperatorio en cirugía cardíaca de adultos. 2023.
Dyke C, Aronson S, Dietrich W, et al. Universal definition of peri-operative bleeding in adult cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 2014; 147: 1458–63; e1.
Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, Fries D, Görlinger K, Haas T, Imberger G, Jacob M, Lancé M, Llau J, Mallett S, Meier J, Rahe-Meyer N, Samama CM, Smith A, Solomon C, Van der Linden P, Wikkelsø AJ, Wouters P, Wyffels P. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013 Jun;30(6):270-382.
Yang L, Stanworth S, Baglin T. Cryoprecipitate: an outmoded treatment?. Transfus Med. 2012;22(5):315-320.
Abrahamyan L, Tomlinson G, Callum J, Carcone S, Grewal D, Bartoszko J, Krahn M, Karkouti K. Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients. JAMA Surg. 2023 Mar 1;158(3):245-253.
Nascimento B, Levy JH, Tien H, Da Luz LT. Cryoprecipitate transfusion in bleeding patients. CJEM. 2020 Sep;22(S2):S4-S11.
Nascimento B, Goodnough LT, Levy JH. Cryoprecipitate therapy. Br J Anaesth. 2014 Dec;113(6):922-34.
Idris SF, Hadjinicolaou AV, Sweeney M, Winthrop C, Balendran G, Besser M. The efficacy and safety of cryoprecipitate in the treatment of acquired hypofibrinogenaemia. Br J Haematol. 2014 Aug;166(3):458-61.
Luo Y, Ma C, Yu Y. Application of fresh frozen plasma transfusion in the management of excessive warfarin-associated anticoagulation. Blood Sci. 2022 May 17;4(2):57-64.
LaPelusa A, Dave HD. Physiology, Hemostasis. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Chaudhry R, Usama SM, Babiker HM. Physiology, Coagulation Pathways. 2022 Aug 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Kriebardis AG, Antonelou MH, Georgatzakou HT, Tzounakas VL, Stamoulis KE, Papassideri IS. Microparticles variability in fresh frozen plasma: preparation protocol and storage time effects. Blood Transfus. 2016 May;14(2):228-37.
Salazar M. Guías para la transfusión de sangre y sus componentes. Revista Panamericana de Salud Pública, 2003; 13(2-3), 183-190.
Baute RG, Falcón DA, Salabert LD, y Almoguea LN. Guía de práctica clínica para la transfusión a pacientes en estado crítico. Medisur, 2009 7(1), 32-41.
Vargas-Ruiz, Á. G. Concentrado de complejo protrombínico y concentrado de fibrinógeno: su papel en el manejo de la hemorragia crítica en el perioperatorio. Revista Mexicana de Anestesiología. 2017;40(S2), 427-430.
Pérez-Calatayud, A., Anica-Malagón, E. D., Zavala-Barrios, B., González-Hernández, G., & Carrillo-Esper, R. Concentrado de fibrinógeno: una opción en el manejo de la hemorragia aguda. Revista Mexicana de Anestesiología, 2016; 39(2), 300-304.
John MJ, Byreddy P, Modak K, Makkar M. Congenital Fibrinogen Deficiency in India and Role of Human Fibrinogen Concentrate. Acta Haematol. 2021;144(6):595-602.
Makris M. Is the continued use of UK plasma sourced cryoprecipitate justified? Br J Haematol. 2015 Mar;168(6):908-10.
Sniecinski RM, Chandler WL. Activation of the hemostatic system during cardiopulmonary bypass. Anesth Analg. 2011 Dec;113(6):1319-33
Hessel EA 2nd. What’s New in Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2019 Aug;33(8):2296-2326.
Despotis GJ, Avidan MS, Hogue CW Jr. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg. 2001 Nov;72(5):S1821-31.
Ho LTS, Lenihan M, McVey MJ, Karkouti K; transfusion avoidance in cardiac surgery study investigators. The association between platelet dysfunction and adverse outcomes in cardiac surgical patients. Anaesthesia. 2019 Sep;74(9):1130-1137.
Riera M, Herrero J, Ibáñez J, Campillo C, Amézaga R, Sáez de Ibarra J.I , Fiol M, Bonnín O, Supervivencia a medio plazo de los pacientes operados en cirugía cardiaca mayor, Revista Española de Cardiología, Volume 64, Issue 6, 2011, Pages 463-469
Karkouti K, Callum J, Crowther MA, McCluskey SA, Pendergrast J, Tait G, Yau TM, Beattie WS. The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesth Analg. 2013 Jul;117(1):14-22.
Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA); Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, Ravn HB, Vonk ABA, Wahba A, Pagano D. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):88-120.
Hinton JV, Xing Z, Fletcher CM, Perry LA, Karamesinis A, Shi J, Ramson DM, Penny-Dimri JC, Liu Z, Coulson TG, Smith JA, Segal R, Bellomo R. Cryoprecipitate Transfusion After Cardiac Surgery. Heart Lung Circ. 2023 Mar;32(3):414-423.
Hinton JV, Xing Z, Fletcher CM, Perry LA, Karamesinis A, Shi J, Ramson DM, Penny-Dimri JC, Liu Z, Williams-Spence J, Coulson TG, Smith JA, Segal R, Bellomo R. Association of perioperative cryoprecipitate transfusion and mortality after cardiac surgery. Ann Thorac Surg. 2023 Mar 11:S0003-4975(23)00273-4.
Okerberg CK, Williams LA III, Kilgore ML, et al.. Crioprecipitado AHF frente a concentrados de fibrinógeno para el reemplazo de fibrinógeno en pacientes con hemorragia adquirida: una evaluación económica . Vox cantó . 2016; 111 ( 3 ): 292-298. doi: 10.1111/vox.12417.
1. Downey LA, Andrews J, Hedlin H, Kamra K, McKenzie ED, Hanley FL, Williams GD, Guzzetta NA. Fibrinogen Concentrate as an Alternative to Cryoprecipitate in a Postcardiopulmonary Transfusion Algorithm in Infants Undergoing Cardiac Surgery: A Prospective Randomized Controlled Trial. Anesth Analg. 2020 Mar;130(3):740-751. 2. Jahangirifard A, Razavi MR, Ahmadi ZH, Forozeshfard M. Effect of Desmopressin on the Amount of Bleeding and Transfusion Requirements in Patients Undergoing Heart Transplant Surgery. Basic Clin Pharmacol Toxicol. 2017 Sep;121(3):175-180. 3. Erdoes G, Koster A, Meesters MI, Ortmann E, Bolliger D, Baryshnikova E, Ahmed A, Lance MD, Ravn HB, Ranucci M, von Heymann C, Agarwal S. The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology. Anaesthesia. 2019 Dec;74(12):1589-1600. 4. Galas FR, de Almeida JP, Fukushima JT, Vincent JL, Osawa EA, Zeferino S, Câmara L, Guimarães VA, Jatene MB, Hajjar LA. Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: a randomized pilot trial. J Thorac Cardiovasc Surg. 2014 Oct;148(4):1647-55. 5. Hess AS, Hess JR, Coursin DB. Should Fibrinogen Concentrate Replace Cryoprecipitate in Cardiac Surgery? JAMA. 2019 Nov 26;322(20):1958-1960. 6. Desborough M, Sandu R, Brunskill SJ, Doree C, Trivella M, Montedori A, Abraha I, Stanworth S. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev. 2015 Jul 14;2015(7):CD007614. 7. Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: a systematic review. Anesth Analg. 2015 Apr;120(4):749-69. 8. Warren OJ, Smith AJ, Alexiou C, Rogers PL, Jawad N, Vincent C, Darzi AW, Athanasiou T. The inflammatory response to cardiopulmonary bypass: part 1--mechanisms of pathogenesis. J Cardiothorac Vasc Anesth. 2009 Apr;23(2):223-31. 9. Callum J, Farkouh ME, Scales DC, Heddle NM, Crowther M, Rao V, Hucke HP, Carroll J, Grewal D, Brar S, Bussières J, Grocott H, Harle C, Pavenski K, Rochon A, Saha T, Shepherd L, Syed S, Tran D, Wong D, Zeller M, Karkouti K; FIBRES Research Group. Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery: The FIBRES Randomized Clinical Trial. JAMA. 2019 Nov 26;322(20):1966-1976. 10. Blasi A, Beltran J, Pereira A, Puig L. The cryoprecipitate: that old unknown. Rev Esp Anestesiol Reanim. 2015 Apr;62(4):204-12. English, Spanish. 11. Herrera Hernández AM, Ramírez Cerón CC, Vargas Rodríguez, J., Bermúdez MI, Beltrán Durán M. Grupo de Bancos de Sangre. Control de calidad de componentes sanguíneos. Documento técnico. 2011. 12. Droubatchevskaia N, Wong MP, Chipperfield KM, Wadsworth LD, Ferguson DJ. Guidelines for cryoprecipitate transfusion. British Columbia Medical Journal, 2007; 49(8), 441. 13. Dunbar NM, Olson NJ, Szczepiorkowski ZM, Martin ED, Tysarcyk RM, Triulzi DJ, Alarcon LH, Yazer MH. Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers. Transfusion. 2017 Jan;57(1):45-52. 14. Yazer MH, Dunbar NM, Cohn C, Dillon J, Eldib H, Jackson B, Kaufman R, Murphy MF, O’Brien K, Raval JS, Seheult J, Staves J, Waters JH; Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Blood product transfusion and wastage rates in obstetric hemorrhage. Transfusion. 2018 Jun;58(6):1408-1413. 15. Jiménez Orduz A. Descripción del abordaje transfusional frente al sangrado intraoperatorio en cirugía cardíaca de adultos. 2023. 16. Dyke C, Aronson S, Dietrich W, et al. Universal definition of peri-operative bleeding in adult cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 2014; 147: 1458–63; e1. 17. Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, Fries D, Görlinger K, Haas T, Imberger G, Jacob M, Lancé M, Llau J, Mallett S, Meier J, Rahe-Meyer N, Samama CM, Smith A, Solomon C, Van der Linden P, Wikkelsø AJ, Wouters P, Wyffels P. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013 Jun;30(6):270-382. 18. Yang L, Stanworth S, Baglin T. Cryoprecipitate: an outmoded treatment?. Transfus Med. 2012;22(5):315-320. 19. Abrahamyan L, Tomlinson G, Callum J, Carcone S, Grewal D, Bartoszko J, Krahn M, Karkouti K. Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients. JAMA Surg. 2023 Mar 1;158(3):245-253. 20. Nascimento B, Levy JH, Tien H, Da Luz LT. Cryoprecipitate transfusion in bleeding patients. CJEM. 2020 Sep;22(S2):S4-S11. 21. Nascimento B, Goodnough LT, Levy JH. Cryoprecipitate therapy. Br J Anaesth. 2014 Dec;113(6):922-34. 22. Idris SF, Hadjinicolaou AV, Sweeney M, Winthrop C, Balendran G, Besser M. The efficacy and safety of cryoprecipitate in the treatment of acquired hypofibrinogenaemia. Br J Haematol. 2014 Aug;166(3):458-61. 23. Luo Y, Ma C, Yu Y. Application of fresh frozen plasma transfusion in the management of excessive warfarin-associated anticoagulation. Blood Sci. 2022 May 17;4(2):57-64. 24. LaPelusa A, Dave HD. Physiology, Hemostasis. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. 25. Chaudhry R, Usama SM, Babiker HM. Physiology, Coagulation Pathways. 2022 Aug 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. 26. Kriebardis AG, Antonelou MH, Georgatzakou HT, Tzounakas VL, Stamoulis KE, Papassideri IS. Microparticles variability in fresh frozen plasma: preparation protocol and storage time effects. Blood Transfus. 2016 May;14(2):228-37. 27. Salazar M. Guías para la transfusión de sangre y sus componentes. Revista Panamericana de Salud Pública, 2003; 13(2-3), 183-190. 28. Baute RG, Falcón DA, Salabert LD, y Almoguea LN. Guía de práctica clínica para la transfusión a pacientes en estado crítico. Medisur, 2009 7(1), 32-41. 29. Vargas-Ruiz, Á. G. Concentrado de complejo protrombínico y concentrado de fibrinógeno: su papel en el manejo de la hemorragia crítica en el perioperatorio. Revista Mexicana de Anestesiología. 2017;40(S2), 427-430. 30. Pérez-Calatayud, A., Anica-Malagón, E. D., Zavala-Barrios, B., González-Hernández, G., & Carrillo-Esper, R. Concentrado de fibrinógeno: una opción en el manejo de la hemorragia aguda. Revista Mexicana de Anestesiología, 2016; 39(2), 300-304. 31. John MJ, Byreddy P, Modak K, Makkar M. Congenital Fibrinogen Deficiency in India and Role of Human Fibrinogen Concentrate. Acta Haematol. 2021;144(6):595-602. 32. Makris M. Is the continued use of UK plasma sourced cryoprecipitate justified? Br J Haematol. 2015 Mar;168(6):908-10. 33. Sniecinski RM, Chandler WL. Activation of the hemostatic system during cardiopulmonary bypass. Anesth Analg. 2011 Dec;113(6):1319-33. 34. Hessel EA 2nd. What’s New in Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2019 Aug;33(8):2296-2326. 35. Despotis GJ, Avidan MS, Hogue CW Jr. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg. 2001 Nov;72(5):S1821-31. 36. Ho LTS, Lenihan M, McVey MJ, Karkouti K; transfusion avoidance in cardiac surgery study investigators. The association between platelet dysfunction and adverse outcomes in cardiac surgical patients. Anaesthesia. 2019 Sep;74(9):1130-1137. 37. Riera M, Herrero J, Ibáñez J, Campillo C, Amézaga R, Sáez de Ibarra J.I , Fiol M, Bonnín O, Supervivencia a medio plazo de los pacientes operados en cirugía cardiaca mayor, Revista Española de Cardiología, Volume 64, Issue 6, 2011, Pages 463-469. 38. Karkouti K, Callum J, Crowther MA, McCluskey SA, Pendergrast J, Tait G, Yau TM, Beattie WS. The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesth Analg. 2013 Jul;117(1):14-22. 39. Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA); Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, Ravn HB, Vonk ABA, Wahba A, Pagano D. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):88-120. 40. Hinton JV, Xing Z, Fletcher CM, Perry LA, Karamesinis A, Shi J, Ramson DM, Penny-Dimri JC, Liu Z, Coulson TG, Smith JA, Segal R, Bellomo R. Cryoprecipitate Transfusion After Cardiac Surgery. Heart Lung Circ. 2023 Mar;32(3):414-423. 41. Hinton JV, Xing Z, Fletcher CM, Perry LA, Karamesinis A, Shi J, Ramson DM, Penny-Dimri JC, Liu Z, Williams-Spence J, Coulson TG, Smith JA, Segal R, Bellomo R. Association of perioperative cryoprecipitate transfusion and mortality after cardiac surgery. Ann Thorac Surg. 2023 Mar 11:S0003-4975(23)00273-4. 42. Okerberg CK, Williams LA III, Kilgore ML, et al.. Crioprecipitado AHF frente a concentrados de fibrinógeno para el reemplazo de fibrinógeno en pacientes con hemorragia adquirida: una evaluación económica . Vox cantó . 2016; 111 ( 3 ): 292-298. doi: 10.1111/vox.12417. 43. Kwapisz MM, Kent B, DiQuinzio C, LeGare JF, Garnett S, Swyer W, Whynot S, Mingo H, Scheffler M. The prophylactic use of fibrinogen concentrate in high-risk cardiac surgery. Acta Anaesthesiol Scand. 2020 May;64(5):602-612. doi: 10.1111/aas.13540. Epub 2020 Jan 17. PMID: 31889306.
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spelling Montes, Félix Ramóndfbda9df-275f-4ff8-9641-e96074cc0773-1Patiño, Angélica María111d1813-15d0-401f-bc53-de178fde556a-1Mantilla, Hugo Andrésc4e6c5f3-d930-4521-aec4-60b9ea9484bb-1Díaz Ramírez, JuliethJaramillo Gutierrez, Juan JoséEspecialista en AnestesiologíaMaestríaFull time344a91fb-2992-4dd6-9d21-7cc5743227c0-15c2e70d0-5499-4900-9093-a00cc31e8b54-12023-07-18T12:28:06Z2023-07-18T12:28:06Z2023-07-17info:eu-repo/date/embargoEnd/2025-07-18Introducción: La cirugía cardiaca con bypass cardiopulmonar es un procedimiento con alto riesgo de sangrado, requiere anticoagulación y puede inducir coagulopatía. El fibrinógeno experimenta una reducción crítica, para restaurar sus niveles, se pueden utilizar 4 gramos de concentrado de fibrinógeno o crioprecipitados. En Colombia se usan crioprecipitados, la cantidad de fibrinógeno presente en cada unidad es variable, una característica intrínseca de estos. Objetivo: Determinar si la dosis de fibrinógeno administrada mediante crioprecipitados en el perioperatorio de cirugía con BCP en LaCardio-IC es menor a la sugerida actualmente. Metodología: Estudio observacional de cohorte retrospectiva. En adultos sometidos a cirugía con BCP en LaCardio-IC entre abril del 2020 y marzo de 2023 que recibieron crioprecipitados durante la cirugía o en las 48 horas siguientes a la intervención. Resultado: 1350 cirugías con BCP fueron realizadas en el periodo de estudio, 335 recibieron crioprecipitados. La primera dosis intraoperatoria fue de 1,1 unidades por cada 10 kg y 0,99 unidades por cada 10 kg de peso en el posoperatorio, lo cual es acorde con la literatura. Sin embargo; la cantidad media de fibrinógeno en la primera dosis intraoperatoria fue de 2399 mg y 3152 mg en la dosis total intraoperatoria fue de 3152 mg, menor a los 4 gr actualmente sugeridos (p < 0,05). Conclusión: La dosis de crioprecipitados en cirugía bypass cardiopulmonar en LaCardio-IC durante el periodo de estudio es acorde a la literatura actual, pero el fibrinógeno contenido en las unidades de crioprecipitados transfundidas es menor a la actualmente recomendada.Introduction: Surgery with cardiopulmonary bypass is a procedure with a high risk of bleeding, reqires anticoagulation and may induce coagulopathy. Fibrinogen undergoes a critical reduction, to restore its levels, 4 grams of fibrinogen concentrate or cryoprecipitates can be used. In Colombia cryoprecipitates are used, the amount of fibrinogen present in each unit is variable, an intrinsic characteristic of these. Objective: To determine whether the dose of fibrinogen administered through cryoprecipitates is subtherapeutic compared to current recommendations of the perioperative period of cardiac surgery. Methodology: Observational retrospective cohort study. In adults undergoing cardiac surgery with CPB at LaCardio-IC between April 2020 and March 2023 who received cryoprecipitate during surgery or within 48 hours of the intervention. Result: 1350 surgeries with cardiopulmonary bypass were performed during the study period; 335 received cryoprecipitate transfusion. It was determined that the first intraoperative dose was 1.1 units per 10 kg and total postoperative dose was 0.99 units per 10 kg of weight, which is in accordance with literature. However, it was also determined that the mean amount of fibrinogen in the first intraoperative dose was 2399 mg, while the mean amount of fibrinogen in the total intraoperative dose was 3152 mg, which is less than the 4 grams currently suggested (p < 0,05). Conclusion: The dose of cryoprecipitates in surgery with cardiopulmonary bypass at LaCardio-IC during the study period is in accordance with the literature, but the dose of fibrinogen contained in the units of cryoprecipitates transfused is lower than that currently recommended.63application/pdfhttps://doi.org/10.48713/10336_40193 https://repository.urosario.edu.co/handle/10336/40193spaUniversidad del RosarioEscuela de Medicina y Ciencias de la SaludEspecialización en Anestesiología FCIAttribution-NonCommercial-ShareAlike 4.0 InternationalRestringido (Temporalmente bloqueado)EL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.http://creativecommons.org/licenses/by-nc-sa/4.0/http://purl.org/coar/access_right/c_f1cfDowney LA, Andrews J, Hedlin H, Kamra K, McKenzie ED, Hanley FL, Williams GD, Guzzetta NA. Fibrinogen Concentrate as an Alternative to Cryoprecipitate in a Postcardiopulmonary Transfusion Algorithm in Infants Undergoing Cardiac Surgery: A Prospective Randomized Controlled Trial. Anesth Analg. 2020 Mar;130(3):740-751.Jahangirifard A, Razavi MR, Ahmadi ZH, Forozeshfard M. Effect of Desmopressin on the Amount of Bleeding and Transfusion Requirements in Patients Undergoing Heart Transplant Surgery. Basic Clin Pharmacol Toxicol. 2017 Sep;121(3):175-180.Erdoes G, Koster A, Meesters MI, Ortmann E, Bolliger D, Baryshnikova E, Ahmed A, Lance MD, Ravn HB, Ranucci M, von Heymann C, Agarwal S. The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology. Anaesthesia. 2019 Dec;74(12):1589-1600.Galas FR, de Almeida JP, Fukushima JT, Vincent JL, Osawa EA, Zeferino S, Câmara L, Guimarães VA, Jatene MB, Hajjar LA. Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: a randomized pilot trial. J Thorac Cardiovasc Surg. 2014 Oct;148(4):1647-55.Hess AS, Hess JR, Coursin DB. Should Fibrinogen Concentrate Replace Cryoprecipitate in Cardiac Surgery? JAMA. 2019 Nov 26;322(20):1958-1960.Desborough M, Sandu R, Brunskill SJ, Doree C, Trivella M, Montedori A, Abraha I, Stanworth S. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev. 2015 Jul 14;2015(7):CD007614.Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: a systematic review. Anesth Analg. 2015 Apr;120(4):749-69Warren OJ, Smith AJ, Alexiou C, Rogers PL, Jawad N, Vincent C, Darzi AW, Athanasiou T. The inflammatory response to cardiopulmonary bypass: part 1--mechanisms of pathogenesis. J Cardiothorac Vasc Anesth. 2009 Apr;23(2):223-31.Callum J, Farkouh ME, Scales DC, Heddle NM, Crowther M, Rao V, Hucke HP, Carroll J, Grewal D, Brar S, Bussières J, Grocott H, Harle C, Pavenski K, Rochon A, Saha T, Shepherd L, Syed S, Tran D, Wong D, Zeller M, Karkouti K; FIBRES Research Group. Effect of Fibrinogen Concentrate vs Cryoprecipitate on BloodBlasi A, Beltran J, Pereira A, Puig L. The cryoprecipitate: that old unknown. Rev Esp Anestesiol Reanim. 2015 Apr;62(4):204-12. English, Spanish.Herrera Hernández AM, Ramírez Cerón CC, Vargas Rodríguez, J., Bermúdez MI, Beltrán Durán M. Grupo de Bancos de Sangre. Control de calidad de componentes sanguíneos. Documento técnico. 2011.Droubatchevskaia N, Wong MP, Chipperfield KM, Wadsworth LD, Ferguson DJ. Guidelines for cryoprecipitate transfusion. British Columbia Medical Journal, 2007; 49(8), 441.Dunbar NM, Olson NJ, Szczepiorkowski ZM, Martin ED, Tysarcyk RM, Triulzi DJ, Alarcon LH, Yazer MH. Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers. Transfusion. 2017 Jan;57(1):45-52.Yazer MH, Dunbar NM, Cohn C, Dillon J, Eldib H, Jackson B, Kaufman R, Murphy MF, O’Brien K, Raval JS, Seheult J, Staves J, Waters JH; Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Blood product transfusion and wastage rates in obstetric hemorrhage. Transfusion. 2018 Jun;58(6):1408-1413.Jiménez Orduz A. Descripción del abordaje transfusional frente al sangrado intraoperatorio en cirugía cardíaca de adultos. 2023.Dyke C, Aronson S, Dietrich W, et al. Universal definition of peri-operative bleeding in adult cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 2014; 147: 1458–63; e1.Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, Fries D, Görlinger K, Haas T, Imberger G, Jacob M, Lancé M, Llau J, Mallett S, Meier J, Rahe-Meyer N, Samama CM, Smith A, Solomon C, Van der Linden P, Wikkelsø AJ, Wouters P, Wyffels P. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013 Jun;30(6):270-382.Yang L, Stanworth S, Baglin T. Cryoprecipitate: an outmoded treatment?. Transfus Med. 2012;22(5):315-320.Abrahamyan L, Tomlinson G, Callum J, Carcone S, Grewal D, Bartoszko J, Krahn M, Karkouti K. Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients. JAMA Surg. 2023 Mar 1;158(3):245-253.Nascimento B, Levy JH, Tien H, Da Luz LT. Cryoprecipitate transfusion in bleeding patients. CJEM. 2020 Sep;22(S2):S4-S11.Nascimento B, Goodnough LT, Levy JH. Cryoprecipitate therapy. Br J Anaesth. 2014 Dec;113(6):922-34.Idris SF, Hadjinicolaou AV, Sweeney M, Winthrop C, Balendran G, Besser M. The efficacy and safety of cryoprecipitate in the treatment of acquired hypofibrinogenaemia. Br J Haematol. 2014 Aug;166(3):458-61.Luo Y, Ma C, Yu Y. Application of fresh frozen plasma transfusion in the management of excessive warfarin-associated anticoagulation. Blood Sci. 2022 May 17;4(2):57-64.LaPelusa A, Dave HD. Physiology, Hemostasis. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.Chaudhry R, Usama SM, Babiker HM. Physiology, Coagulation Pathways. 2022 Aug 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.Kriebardis AG, Antonelou MH, Georgatzakou HT, Tzounakas VL, Stamoulis KE, Papassideri IS. Microparticles variability in fresh frozen plasma: preparation protocol and storage time effects. Blood Transfus. 2016 May;14(2):228-37.Salazar M. Guías para la transfusión de sangre y sus componentes. Revista Panamericana de Salud Pública, 2003; 13(2-3), 183-190.Baute RG, Falcón DA, Salabert LD, y Almoguea LN. Guía de práctica clínica para la transfusión a pacientes en estado crítico. Medisur, 2009 7(1), 32-41.Vargas-Ruiz, Á. G. Concentrado de complejo protrombínico y concentrado de fibrinógeno: su papel en el manejo de la hemorragia crítica en el perioperatorio. Revista Mexicana de Anestesiología. 2017;40(S2), 427-430.Pérez-Calatayud, A., Anica-Malagón, E. D., Zavala-Barrios, B., González-Hernández, G., & Carrillo-Esper, R. Concentrado de fibrinógeno: una opción en el manejo de la hemorragia aguda. Revista Mexicana de Anestesiología, 2016; 39(2), 300-304.John MJ, Byreddy P, Modak K, Makkar M. Congenital Fibrinogen Deficiency in India and Role of Human Fibrinogen Concentrate. Acta Haematol. 2021;144(6):595-602.Makris M. Is the continued use of UK plasma sourced cryoprecipitate justified? Br J Haematol. 2015 Mar;168(6):908-10.Sniecinski RM, Chandler WL. Activation of the hemostatic system during cardiopulmonary bypass. Anesth Analg. 2011 Dec;113(6):1319-33Hessel EA 2nd. What’s New in Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2019 Aug;33(8):2296-2326.Despotis GJ, Avidan MS, Hogue CW Jr. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg. 2001 Nov;72(5):S1821-31.Ho LTS, Lenihan M, McVey MJ, Karkouti K; transfusion avoidance in cardiac surgery study investigators. The association between platelet dysfunction and adverse outcomes in cardiac surgical patients. Anaesthesia. 2019 Sep;74(9):1130-1137.Riera M, Herrero J, Ibáñez J, Campillo C, Amézaga R, Sáez de Ibarra J.I , Fiol M, Bonnín O, Supervivencia a medio plazo de los pacientes operados en cirugía cardiaca mayor, Revista Española de Cardiología, Volume 64, Issue 6, 2011, Pages 463-469Karkouti K, Callum J, Crowther MA, McCluskey SA, Pendergrast J, Tait G, Yau TM, Beattie WS. The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesth Analg. 2013 Jul;117(1):14-22.Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA); Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, Ravn HB, Vonk ABA, Wahba A, Pagano D. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):88-120.Hinton JV, Xing Z, Fletcher CM, Perry LA, Karamesinis A, Shi J, Ramson DM, Penny-Dimri JC, Liu Z, Coulson TG, Smith JA, Segal R, Bellomo R. Cryoprecipitate Transfusion After Cardiac Surgery. Heart Lung Circ. 2023 Mar;32(3):414-423.Hinton JV, Xing Z, Fletcher CM, Perry LA, Karamesinis A, Shi J, Ramson DM, Penny-Dimri JC, Liu Z, Williams-Spence J, Coulson TG, Smith JA, Segal R, Bellomo R. Association of perioperative cryoprecipitate transfusion and mortality after cardiac surgery. Ann Thorac Surg. 2023 Mar 11:S0003-4975(23)00273-4.Okerberg CK, Williams LA III, Kilgore ML, et al.. Crioprecipitado AHF frente a concentrados de fibrinógeno para el reemplazo de fibrinógeno en pacientes con hemorragia adquirida: una evaluación económica . Vox cantó . 2016; 111 ( 3 ): 292-298. doi: 10.1111/vox.12417.1. Downey LA, Andrews J, Hedlin H, Kamra K, McKenzie ED, Hanley FL, Williams GD, Guzzetta NA. Fibrinogen Concentrate as an Alternative to Cryoprecipitate in a Postcardiopulmonary Transfusion Algorithm in Infants Undergoing Cardiac Surgery: A Prospective Randomized Controlled Trial. Anesth Analg. 2020 Mar;130(3):740-751. 2. Jahangirifard A, Razavi MR, Ahmadi ZH, Forozeshfard M. Effect of Desmopressin on the Amount of Bleeding and Transfusion Requirements in Patients Undergoing Heart Transplant Surgery. Basic Clin Pharmacol Toxicol. 2017 Sep;121(3):175-180. 3. Erdoes G, Koster A, Meesters MI, Ortmann E, Bolliger D, Baryshnikova E, Ahmed A, Lance MD, Ravn HB, Ranucci M, von Heymann C, Agarwal S. The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology. Anaesthesia. 2019 Dec;74(12):1589-1600. 4. Galas FR, de Almeida JP, Fukushima JT, Vincent JL, Osawa EA, Zeferino S, Câmara L, Guimarães VA, Jatene MB, Hajjar LA. Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: a randomized pilot trial. J Thorac Cardiovasc Surg. 2014 Oct;148(4):1647-55. 5. Hess AS, Hess JR, Coursin DB. Should Fibrinogen Concentrate Replace Cryoprecipitate in Cardiac Surgery? JAMA. 2019 Nov 26;322(20):1958-1960. 6. Desborough M, Sandu R, Brunskill SJ, Doree C, Trivella M, Montedori A, Abraha I, Stanworth S. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev. 2015 Jul 14;2015(7):CD007614. 7. Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: a systematic review. Anesth Analg. 2015 Apr;120(4):749-69. 8. Warren OJ, Smith AJ, Alexiou C, Rogers PL, Jawad N, Vincent C, Darzi AW, Athanasiou T. The inflammatory response to cardiopulmonary bypass: part 1--mechanisms of pathogenesis. J Cardiothorac Vasc Anesth. 2009 Apr;23(2):223-31. 9. Callum J, Farkouh ME, Scales DC, Heddle NM, Crowther M, Rao V, Hucke HP, Carroll J, Grewal D, Brar S, Bussières J, Grocott H, Harle C, Pavenski K, Rochon A, Saha T, Shepherd L, Syed S, Tran D, Wong D, Zeller M, Karkouti K; FIBRES Research Group. Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery: The FIBRES Randomized Clinical Trial. JAMA. 2019 Nov 26;322(20):1966-1976. 10. Blasi A, Beltran J, Pereira A, Puig L. The cryoprecipitate: that old unknown. Rev Esp Anestesiol Reanim. 2015 Apr;62(4):204-12. English, Spanish. 11. Herrera Hernández AM, Ramírez Cerón CC, Vargas Rodríguez, J., Bermúdez MI, Beltrán Durán M. Grupo de Bancos de Sangre. Control de calidad de componentes sanguíneos. Documento técnico. 2011. 12. Droubatchevskaia N, Wong MP, Chipperfield KM, Wadsworth LD, Ferguson DJ. Guidelines for cryoprecipitate transfusion. British Columbia Medical Journal, 2007; 49(8), 441. 13. Dunbar NM, Olson NJ, Szczepiorkowski ZM, Martin ED, Tysarcyk RM, Triulzi DJ, Alarcon LH, Yazer MH. Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers. Transfusion. 2017 Jan;57(1):45-52. 14. Yazer MH, Dunbar NM, Cohn C, Dillon J, Eldib H, Jackson B, Kaufman R, Murphy MF, O’Brien K, Raval JS, Seheult J, Staves J, Waters JH; Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Blood product transfusion and wastage rates in obstetric hemorrhage. Transfusion. 2018 Jun;58(6):1408-1413. 15. Jiménez Orduz A. Descripción del abordaje transfusional frente al sangrado intraoperatorio en cirugía cardíaca de adultos. 2023. 16. Dyke C, Aronson S, Dietrich W, et al. Universal definition of peri-operative bleeding in adult cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 2014; 147: 1458–63; e1. 17. Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, Fries D, Görlinger K, Haas T, Imberger G, Jacob M, Lancé M, Llau J, Mallett S, Meier J, Rahe-Meyer N, Samama CM, Smith A, Solomon C, Van der Linden P, Wikkelsø AJ, Wouters P, Wyffels P. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013 Jun;30(6):270-382. 18. Yang L, Stanworth S, Baglin T. Cryoprecipitate: an outmoded treatment?. Transfus Med. 2012;22(5):315-320. 19. Abrahamyan L, Tomlinson G, Callum J, Carcone S, Grewal D, Bartoszko J, Krahn M, Karkouti K. Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients. JAMA Surg. 2023 Mar 1;158(3):245-253. 20. Nascimento B, Levy JH, Tien H, Da Luz LT. Cryoprecipitate transfusion in bleeding patients. CJEM. 2020 Sep;22(S2):S4-S11. 21. Nascimento B, Goodnough LT, Levy JH. Cryoprecipitate therapy. Br J Anaesth. 2014 Dec;113(6):922-34. 22. Idris SF, Hadjinicolaou AV, Sweeney M, Winthrop C, Balendran G, Besser M. The efficacy and safety of cryoprecipitate in the treatment of acquired hypofibrinogenaemia. Br J Haematol. 2014 Aug;166(3):458-61. 23. Luo Y, Ma C, Yu Y. Application of fresh frozen plasma transfusion in the management of excessive warfarin-associated anticoagulation. Blood Sci. 2022 May 17;4(2):57-64. 24. LaPelusa A, Dave HD. Physiology, Hemostasis. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. 25. Chaudhry R, Usama SM, Babiker HM. Physiology, Coagulation Pathways. 2022 Aug 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. 26. Kriebardis AG, Antonelou MH, Georgatzakou HT, Tzounakas VL, Stamoulis KE, Papassideri IS. Microparticles variability in fresh frozen plasma: preparation protocol and storage time effects. Blood Transfus. 2016 May;14(2):228-37. 27. Salazar M. Guías para la transfusión de sangre y sus componentes. Revista Panamericana de Salud Pública, 2003; 13(2-3), 183-190. 28. Baute RG, Falcón DA, Salabert LD, y Almoguea LN. Guía de práctica clínica para la transfusión a pacientes en estado crítico. Medisur, 2009 7(1), 32-41. 29. Vargas-Ruiz, Á. G. Concentrado de complejo protrombínico y concentrado de fibrinógeno: su papel en el manejo de la hemorragia crítica en el perioperatorio. Revista Mexicana de Anestesiología. 2017;40(S2), 427-430. 30. Pérez-Calatayud, A., Anica-Malagón, E. D., Zavala-Barrios, B., González-Hernández, G., & Carrillo-Esper, R. 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