Diagnostics · 6 authors, 3 centres
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This prospective cohort study of 195 patients undergoing hip arthroplasty found no association between preoperative plasma fibrinogen levels and the need for perioperative blood transfusion. The study concludes that preoperative fibrinogen measurement is not an effective biomarker for predicting transfusion risk in this population.
Fibrinogen is a key coagulation factor, and low levels (<200 mg/dL) are associated with increased bleeding risk in some surgical populations. This study aimed to determine if preoperative fibrinogen levels predict perioperative blood transfusion in major nontraumatic orthopedic surgery. Methods: A prospective cohort study enrolled 195 patients undergoing hip arthroplasty or revision. Preoperative fibrinogen (Clauss method), blood counts, and coagulation tests were measured. The primary outcome was blood-product transfusion within 48 hours. Statistical analysis included chi-square, t-tests, and calculation of diagnostic test characteristics. Key Results: The mean preoperative fibrinogen was 315 (83) mg/dL. Only 13 patients (6.6%) had levels <200 mg/dL, and only one of them received a transfusion (absolute risk 7.69%). There was no statistically significant association between preoperative fibrinogen and transfusion need (p = 0.745). The sensitivity and positive predictive value of fibrinogen <200 mg/dL as a predictor were very low (4.17% and 7.69%, respectively). Preoperative hemoglobin and hematocrit were associated with transfusion rates. Limitations: This was a single-center observational study with a low prevalence of hypofibrinogenemia (6.6%), which may have reduced the positive predictive value. The study did not measure intraoperative bleeding volume. Implications: In this cohort of nontraumatic hip arthroplasty patients, preoperative plasma fibrinogen is not an effective biomarker for predicting perioperative blood transfusion. The findings suggest that routine preoperative fibrinogen measurement for transfusion risk assessment in this setting is unnecessary.
