PB0487 - FXIII CONCENTRATE USE IN UNCONTRALABLE BLEEDING AFTER CARDIAC SURGERY– WHAT IS THE ROLE? – A CASE REPORT

Background: Bleeding disorders in extracorporeal circulation remains a challenge. FXIII plays a critical role in clot stabilization which can be affected in patients submitted to cardiac surgery.

Aims: To present a case report of FXIII concentrate use in a bleeding diastasis of difficult control after cardiac surgery.

Methods: A 30-years-old woman recipient of a orthotopic heart transplant at 20 years of age due to familial dilated cardiomyopathy entered to the emergency department after several syncope episodes. On transthoracic echocardiogram she presented moderately impaired left ventricular systolic function and akinesia of the middle and basal segments of the inferior and posterior wall. Heart catheterization showed anterior descending artery with 70% stenosis, circumflex artery with 90% stenosis and right coronary artery with 50% stenosis. After team discussion coronary artery bypass graft (CABG) was performed.

Results: CABG was likely preceded by a perioperative acute myocardial infarction with need to rebuild vascular bridges and consequent prolongation of the cardiopulmonary bypass time. Hemorrhagic diathesis of difficult control ensued despite massive transfusion – 11 erythrocyte concentrate (EC), 12 Fresh Frozen Plasma (FFP), 3 platelet concentrates (PC) and 4 gr of fibrinogen- ECMO team was then mobilized. The patient remained in cardiogenic/hypovolemic shock and was reintervened needing 3 EC, cell-saver, 4 FFP, 2 gr of fibrinogen, 1 PC, 1000 IU of prothrombin complex concentrate and desmopressin. Due to deterioration of clinical state she underwent surgery again, bleeding tendency persisted, ROTEM results as on table 2 and FXIII of 57%, 6 EC, 1 PC, 4 FFP, 4 gr of fibrinogen and 2000 IU of FXIII (40 UI/kg) were administered. After all the transfusion products and surgical haemostasis the bleeding was controlled.

Conclusion(s): Cardiac surgery is a challenge in what concerns haemostasis and detailed consideration of all moments of coagulation is necessary trying to optimize care of these patients.