JAP Volume 7 Issue 1 News
From the editor… Please send your news to
editor@japractice.com All the great substance, all new package
Welcome, dear readers, to the new and improved Journal of Anaesthesia Practice. New year, new look, making it even easier for you to get to whatever interests you, be it news, products, features or all of the above.
Apart from our image-improvement, this year’s not got off to
the best start, being rather snowy, slippery – making A&E busier and waiting times longer – and just generally pretty chilly. Even so, I can’t imagine it’s a patch on the chill in the air at
the offices of the NHS bosses, when the Francis report came to light to expose all the cracks and failings at the NHS following
News
Bleeding heart surgery Human fibrinogen concentrate restores clotting ability and can
significantly reduce the need for blood transfusion when given as an intra-operative, targeted first-line haemostatic therapy in bleeding patients undergoing aortic replacement surgery. The Phase II prospective study, published in Anesthesiology,
performed at the Hannover Medical School, Germany, enrolled 61 patients to assess the ability of fibrinogen concentrate to improve clotting and reduce the need for transfusion following elective aortic replacement surgery with cardiopulmonary bypass (CPB). Patients who received fibrinogen concentrate required fewer allogeneic blood product transfusions than patients receiving placebo (a median of two units in the fibrinogen concentrate group compared with 13 units in the placebo (p<0.001)). In the fibrinogen concentrate group, 45 percent (13 out of 29 patients) avoided transfusion entirely, whereas all 32 patients receiving placebo required transfusion (p<0.001). The study enrolled patients 18 years or older who were undergoing elective aortic replacement surgery with cardiopulmonary bypass. Patients were excluded from the study if they had undergone previous surgery at the same aortic site, had a congenital or acquired coagulation disorder, had a myocardial infarction or stroke in the previous two months, or if they used aspirin, clopidogrel or vitamin K antagonists before the surgery. “Aortic replacement surgery puts patients at risk of potentially
life-threatening bleeding events because the surgery depletes fibrinogen levels and delays clotting, which may require extensive blood transfusion to restore a patient’s clotting ability,” said Niels Rahe-Meyer, M.D. Ph.D., of the Clinic for Anaesthesiology and Intensive Care Medicine, Hannover Medical School and lead author of the study. “This is the largest study of its kind in patients undergoing aortic replacement surgery and indicates that proactive treatment with fibrinogen concentrate may reduce the need for
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transfusions, restore clotting ability, and consequently protect aortic surgery patients from possible adverse events associated with donor blood transfusion.” In the study, reported treatment-emergent adverse events
were similar in both groups and typical for patients undergoing cardiac surgery, with the most common being fluid build-up around the lungs (pleural effusion) and abnormal heart rhythm (atrial
“Aortic replacement surgery puts patients at risk of potentially life-threatening bleeding”
fibrillation). None of the treatment-emergent adverse events were ascribed to study medication or led to discontinuation from the study. Overall there was no observed safety concern using fibrinogen concentrate during aortic surgery. In addition to bleeding caused by injury or a surgical intervention itself (surgical bleeding), critical reduction in the level of coagulation factors can lead to additional non-surgical bleeding complications that can be difficult to control (e.g. coagulopathic bleeding). Such patients can have critically low concentrations of many coagulation factors. The first factor to be depleted during CPB is fibrinogen. A simple blood test can detect the level of fibrinogen; the normal range is 150–450mg per decilitre. “Fibrinogen concentrate has been well characterised for the treatment of specific inherited blood clotting disorders,” said Andrew Cuthbertson, CSL Behring Chief Scientist. “CSL Behring is committed to exploring the use of fibrinogen concentrate in patients at high risk of bleeding, particularly those in the hospital setting where fibrinogen has been shown to be depleted by surgical procedures and where a quick intervention is needed to improve clotting and prevent serious bleeding events.” For more information, visit
www.cslbehring.co.uk.
the Mid-Staffs scandal. We’ve been covering the Francis report development on our Facebook page (search for Journal of Anaesthesia Practice) and on Twitter (@JnlAnaesthesia), so follow us for the latest on this and more from the world of anaesthesia. In the news, bigger risk from cigarette smoke to undeveloped lungs (p10) and electric stimulation to the brain may ease chronic pain (p08). Also, read our fascinating features on TAVI (p22), the Blood-Brain barrier (p20) and acronyms in anaesthesia (p16).
Matt Ng, Editor E:
matt.ng@
barkerbrooks.co.uk T: 0844 858 2890
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