HPE CSL Managing Perioperative Bleeding handbook - Page 9

Pathophysiology surgery with cardiopulmonary bypass especially in newborns and infants; resuscitation of trauma patients), or excessive fibrinogen breakdown (hyperfibrinolysis). Low levels of fibrinogen may lead to an increased risk of bleeding. The clinical scenarios where this condition is more common include sepsis with DIC, cardiac surgery with cardiopulmonary bypass, trauma, post-partum haemorrhage, and liver surgery. Usually, a fibrinogen level <1.5 g/dl is considered at risk for fibrinogen-dependent bleeding, but this value may change depending on the different clinical scenarios. DIC is usually accompanied by low levels of fibrinogen, as a marker of intravascular coagulation and consumption of coagulation factors. The existing DIC scores include a fibrinogen level <1.0g/l within the diagnostic score. However, it should be considered that when DIC occurs in the setting of sepsis, consumption of fibrinogen may be relevant even when the fibrinogen levels are higher: this is related to the fact that in the early phases of bloodstream infection and sepsis, the fibrinogen levels are increased above the normal levels, as an effect of the acute phase reaction. In trauma patients, the main mechanism leading to low fibrinogen hospitalpharmacyeurope.com 9