Comments on 'U-shaped relationship between preoperative plasma fibrinogen levels and severe peri-operative bleeding in cardiac surgery: A report from the Perioperative Events aSSessment in Adult Cardiac surgery (PESSAC) registry' by Mion et al.

Authors: Mayeur, N; Savy, N; Charbonneau, H.

Affiliations: Cardiac and thoracic surgery and intensive care (NM, HC), Toulouse Mathematics Institute (NS), UMR5219-University of Toulouse; CNRS-UPS IMT F-31062 Toulouse Cedex 9, France.

Publication: European Journal of Anaesthesiology. 2021. 38. 1207–1208. October 2021

ABSTRACT: Editor, We read with great interest the article entitled ‘U-shaped relationship between preoperative plasma fibrinogenlevels and severe peri-operative bleeding in cardiac surgery: A report from the Perioperative Events aSSessment in Adult Cardiac surgery (PESSAC) registry’.¹ Mion et al. conducted a large, retrospective, single-centre study in patients who underwent cardiac surgery with cardiopulmonary bypass to evaluate the relationship between plasma fibrinogen levels (PFL) and the risk of severe peri-operative bleeding. Surprisingly, their results showed that although a low level of fibrinogen appeared to be associated with a high risk of bleeding, a high level of fibrinogen did not necessarily protect the patient against the risk and could even be associated with severe peri-operative bleeding. In the study by Mion et al., severe bleeding was defined as class 3 or 4 according to the Universal Definition of Perioperative Bleeding (UDPB).2 This definition is more clinically relevant as it is based not only on peri-operative blood loss but also on peri-operative administration of both blood products and pharmacological haemostatic agents.