To the Editor The randomized clinical trial by Dr Bilecen and colleagues1 showed no benefit of fibrinogen (factor I) concentrate use compared with placebo on intraoperative blood loss in patients with bleeding following high-risk cardiac procedures. We believe that the results may unfairly characterize fibrinogen concentrate use.
First, the authors chose intraoperative blood loss as their primary study end point. However, intraoperative blood loss is less relevant in cardiac surgery than blood loss that occurs after chest closure.2 Unfortunately, 24-hour blood loss, which showed a significant reduction in the fibrinogen concentrate group, was a secondary end point.
Meesters MI, von Heymann C, Boer C. Administration of Fibrinogen Concentrate During Cardiac Surgery. JAMA. 2017;317(24):2550-2551. doi:10.1001/jama.2017.6219