4-Group Classification of Kawashima et al for Postoperative Bleeding After Cardiopulmonary Bypass Based on Fibrinogen and ROTEM (Fuji-san Classification)

Description

Kawashima et al developed a four-group classification for patients undergoing cardiac surgery with cardiopulmonary bypass based on coagulation tests. This can help to identify risk of a coagulopathy and need for transfusion with fresh frozen plasma (FFP). The authors are from Hamamatsu Univeristy, Rosai Hospital and Iwata City Hospital in Japan.

Patient selection: cardiac surgery with cardiopulmonary bypass

Parameters:

(1) plasma fibrinogen in mg/dL

(2) FIBTEM test by ROTEM (Tem International GmbH) in mm at 10 minutes. The FIBTEM uses extrinsic activation with human recombinant tissue factor and the platelet inhibitor cytochalasin D resulting in a pure fibrin clot.

A FIBTEM < 6 mm at 10 minutes is associated indicates low fibrin polymerization.

Plasma Fibrinogen	FIBTEM	Group
>= 150 mg/dL	>= 6 mm	I
< 150 mg/dL	>= 6 mm	II
< 150 mg/dL	< 6 mm	III
>= 150 mg/dL	< 6 mm	IV

Group	FFP Transfusion
I	0 mL
II	<= 480 mL
III	>= 480 mL
IV	>= 720 mL

where:

• Cryoprecipitate was not mentioned as a blood product for fibrinogen replacement.

Aggressive FFP transfusion therapy for patients at risk for bleeding reduced the need for red blood cell products during and after surgery.

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4-Group Classification of Kawashima et al for Postoperative Bleeding After Cardiopulmonary Bypass Based on Fibrinogen and ROTEM (Fuji-san Classification)

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