The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Prophylactic Fibrinogen Reduces Excessive Bleeding in Total Hip Arthroplasty Surgery: A Randomized Double-blinded Placebo-controlled Trial

Document Type : RESEARCH PAPER

Authors
Alireza Shakeri 1
Dariush Abtahi 1
Marjan Shahmansouri 1
Alireza Manafi-Rasi 2
1 Department of anesthesiology, Shahid Beheshti University of Medical Science, Tehran, Iran
2 Department of Orthopedics, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22038/abjs.2023.69727.3274
Abstract
Objectives: Excessive blood loss is a critical complication of total hip arthroplasty. We intended to 
determine whether preoperative fibrinogen administration reduces perioperative bleeding and the need 
for blood transfusion in total hip arthroplasty surgery.
Methods: In 4 months, 178 patients who underwent total hip arthroplasty were randomly assigned equally to 
intervention and placebo-control groups in a double-blinded, parallel two-arm randomized controlled trial. Both 
intravenously, 30 min before the start of the surgery, the intervention group received two grams of fibrinogen 
concentrate dissolved in 100 ml of distilled water. In contrast, the control group received 100 ml of normal saline 
solution. The amount of postoperative blood loss served as the main result, and the requirement for blood 
transfusions served as the secondary outcome.
Results: In comparison to the placebo, administering fibrinogen concentrate considerably reduced the amount of 
blood loss (P=0.001) and the requirement for blood transfusions (P=0.004). Patients who got fibrinogen concentrate 
experienced no side effects. In addition, patients in the fibrinogen group had significantly lower hemoglobin and 
higher fibrinogen levels in the recovery room and received lesser blood transfusions (P<0.005) than the placebo 
group.
Conclusion: In total hip arthroplasty, fibrinogen concentrate lessens postoperative bleeding and the requirement 
for blood transfusions.
 Level of evidence: II
Keywords
Bleeding
Fibrinogen
Prophylaxis
Total hip arthroplasty
Subjects
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The Archives of Bone and Joint Surgery
Volume 11, Issue 8
August 2023
Pages 524-530

  • Receive Date 24 December 2022
  • Revise Date 25 June 2023
  • Accept Date 10 June 2023