A patient study conducted in cooperation between the Sahlgrenska Academy and Sahlgrenska University Hospital shows that a substance in the blood, fibrinogen, is important for blood clotting associated with heart surgery. If patients get a dose of fibrinogen before surgery this reduces the risk of bleeding during and after surgery. The findings could open up a completely new treatment in cardiac surgery.

Each year more than 7,000 Swedes undergo open heart surgery, often a so called bypass operation or replacing a heart valve. It is a major procedure and during the surgery the heart and lungs are stopped by using a heart-lung machine that keeps the circulation going.

- But the use of heart-lung machine might imply negative effects on blood clotting and persist during the first hours after surgery. There is therefore a risk of patients bleeding. We do not know for sure why some patients suffer worse than others, and several factors may play a role, said Martin Karlsson doctor at the Sahlgrenska University Hospital and a doctoral student and author of the thesis presented at the Sahlgrenska Academy.

Fibrinogen is one of the main blood coagulationsprotein. The thesis shows that the amount of fibrinogen in the blood is more important for the ability of blood to clot after a heart operation than previously thought.

- We found that the amount of fibrinogen in the blood of patients who are about to undergo a bypass surgery are directly related to how much the patient’s bleeding afterwards and also the need for blood transfusions after surgery. Patients with lower levels of fibrinogen in the blood before surgery are generally more bleeding, even if the levels have previously been perceived as normal and adequate, said Martin Karlsson.

In a substudy patients receiving a bypass operation who had low levels of fibrinogen in the blood were pre-treated with fibrinogenkoncentrat before surgery. In these patients, decreased bleeding and transfusion requirements during and after surgery compared with controls, without evidence of side effects.

- Similar treatment has not previously been tested in patients and the study is called a pilot study, with a small number of patients. Therefore, it is too early to draw firm conclusions but the results are promising and larger studies are already under way, “said Martin Karlsson.

His hope is that the outcome of the pilot study can be confirmed as fibrinogenkoncentrat would be used as a preventative medicine for those patients who will undergo a surgical procedure and there is a high risk of bleeding. It could be a new treatment option for the large number of cardiac patients who undergo surgery each year, and it is also an opportunity for other surgical procedures.

For the full story in Swedish: http://nyheter.vgregion.se/sv/Nyheter/Sahlgrenska-Universitetssjukhuset/Skapa-pressmeddelanden/Ny-behandlingsmetod-i-sikte-inom-hjartkirurgi/