{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:06:47Z","timestamp":1777417607147,"version":"3.51.4"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Fibrinogen replacement therapy (FRT) using fibrinogen concentrate (FC) may rapidly correct hypofibrinogenaemia; however, its clinical impact remains unclear, and this retrospective study aimed to evaluate the safety and efficacy of FC in surgically treated acute type A aortic dissection (ATAAD) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study analysed 87 consecutive ATAAD patients who underwent emergency surgery. Patients were included in 2 groups: those who received FRT (Group F, n\u2009=\u200942) and those who did not (Group C, n\u2009=\u200945). Using a mixed model for repeated measures, we calculated the least squares (LS) mean differences between groups for intraoperative and postoperative fibrinogen levels and blood loss using the LS method. We also evaluated short-term surgical outcomes (postoperative complications) and long-term surgical outcomes (overall survival) for each group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The change in fibrinogen levels during surgery did not differ significantly between groups. Postoperatively, however, the decrease in fibrinogen was smaller in the F group (LSMeans difference: \u221260.1; 95% confidence interval [CI]: \u221279.8, \u221240.4). Intraoperative blood loss was greater in the F group (LSMeans difference: \u2212622 mL; 95% CI, \u22121037, \u2212208), but no difference was observed in postoperative blood loss (LSMeans difference: \u2212131 mL; 95% CI, \u2212547, 286). Despite a higher proportion of severe cases in the F group, the difference in postoperative complication rates was approximately 10%. The difference in 1-month survival rate was 4.9%, and the difference in 1-year survival rate was 19.5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the surgical treatment of ATAAD, FRT increases fibrinogen levels by approximately 71 mg\/dL, achieving adequate haemostasis without increasing adverse outcomes. Additionally, FC is effective in reducing postoperative blood loss in patients with a bleeding tendency whose fibrinogen level is below 150\u202fmg\/dL before weaning from cardiopulmonary bypass.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag075","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:55:25Z","timestamp":1772283325000},"source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Intraoperative Fibrinogen Replacement Therapy on the Clinical Outcome of Surgical Therapy for Type A Acute Aortic Dissection"],"prefix":"10.1093","volume":"41","author":[{"given":"Makoto","family":"Takehara","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital , Hamamatsu, Shizuoka 430-8525,","place":["Japan"]},{"name":"Department of Cardiovascular Surgery, Tenri Hospital , Nara 632-8552,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0781-538X","authenticated-orcid":false,"given":"Takeshi","family":"Shimamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital , Hamamatsu, Shizuoka 430-8525,","place":["Japan"]},{"name":"Department of Cardiovascular Surgery, Kyoto University Hospital , Kyoto 606-8507,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhisa","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital , Hamamatsu, Shizuoka 430-8525,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3637-4429","authenticated-orcid":false,"given":"Yu","family":"Hidaka","sequence":"additional","affiliation":[{"name":"Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University , Kyoto 606-8501,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuriko","family":"Muramatsu","sequence":"additional","affiliation":[{"name":"Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University , Kyoto 606-8501,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7828-9762","authenticated-orcid":false,"given":"Kenji","family":"Minatoya","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Kyoto University Hospital , Kyoto 606-8507,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"2026032300411167600_ivag075-B1","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1001\/jama.2010.1446","article-title":"Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial","volume":"304","author":"Hajjar","year":"2010","journal-title":"JAMA"},{"key":"2026032300411167600_ivag075-B2","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.athoracsur.2013.07.020","article-title":"Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality","volume":"97","author":"Paone","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2026032300411167600_ivag075-B3","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.jss.2020.12.008","article-title":"Clinical simulation model of fibrinogen decline during hemorrhage in major noncardiac surgery","volume":"261","author":"Kikura","year":"2021","journal-title":"J Surg Res"},{"key":"2026032300411167600_ivag075-B4","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1097\/ALN.0b013e3181f22b5a","article-title":"Pathophysiology and treatment of coagulopathy in massive hemorrhage and hemodilution","volume":"113","author":"Bolliger","year":"2010","journal-title":"Anesthesiology"},{"key":"2026032300411167600_ivag075-B5","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1111\/trf.12431","article-title":"Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy","volume":"54","author":"Levy","year":"2014","journal-title":"Transfusion"},{"key":"2026032300411167600_ivag075-B6","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1111\/aas.13540","article-title":"The prophylactic use of fibrinogen concentrate in high-risk cardiac surgery","volume":"64","author":"Kwapisz","year":"2020","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026032300411167600_ivag075-B7","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1111\/jth.12304","article-title":"Postoperative fibrinogen level is associated with postoperative bleeding following cardiothoracic surgery and the effect of fibrinogen replacement therapy remains uncertain","volume":"11","author":"Yang","year":"2013","journal-title":"J Thromb Haemost"},{"key":"2026032300411167600_ivag075-B8","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/1749-8090-9-90","article-title":"Fibrinogen concentrate administration attributes to significant reductions of blood loss and transfusion requirements in thoracic aneurysm repair","volume":"9","author":"Yamamoto","year":"2014","journal-title":"J Cardiothorac Surg"},{"key":"2026032300411167600_ivag075-B9","doi-asserted-by":"publisher","first-page":"2746","DOI":"10.1053\/j.jvca.2019.02.013","article-title":"The coagulopathy of acute type A aortic dissection: a prospective, observational study","volume":"33","author":"Zindovic","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026032300411167600_ivag075-B10","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1055\/s-0037-1603205","article-title":"Low fibrinogen is associated with increased bleeding-related re-exploration after cardiac surgery","volume":"66","author":"Essa","year":"2018","journal-title":"Thorac Cardiovasc Surg"},{"key":"2026032300411167600_ivag075-B11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/bja\/aew169","article-title":"Randomized evaluation of fibrinogen vs placebo in complex cardiovascular surgery (REPLACE): a double-blind phase III study of haemostatic therapy","volume":"117","author":"Rahe-Meyer","year":"2016","journal-title":"Br J Anaesth"},{"key":"2026032300411167600_ivag075-B12","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.1053\/j.jvca.2016.04.015","article-title":"Efficacy and safety of fibrinogen concentrate in surgical patients: a meta-analysis of randomized controlled trials","volume":"30","author":"Fominskiy","year":"2016","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026032300411167600_ivag075-B13","doi-asserted-by":"publisher","first-page":"109782","DOI":"10.1016\/j.jclinane.2020.109782","article-title":"The effect of fibrinogen concentrate on postoperative blood loss: a systematic review and meta-analysis of randomized controlled trials","volume":"63","author":"Ng","year":"2020","journal-title":"J Clin Anesth"},{"key":"2026032300411167600_ivag075-B14","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1213\/ANE.0000000000003508","article-title":"Fibrinogen concentrate in cardiovascular surgery: a meta-analysis of randomized controlled trials","volume":"127","author":"Li","year":"2018","journal-title":"Anesth Analg"},{"key":"2026032300411167600_ivag075-B15","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1093\/bja\/aeu364","article-title":"Perioperative administration of fibrinogen does not increase adverse cardiac and thromboembolic events after cardiac surgery","volume":"114","author":"Fassl","year":"2015","journal-title":"Br J Anaesth"},{"key":"2026032300411167600_ivag075-B16","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1053\/j.jvca.2018.06.001","article-title":"Safety of fibrinogen concentrate and cryoprecipitate in cardiovascular surgery: multicenter database study","volume":"33","author":"Maeda","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026032300411167600_ivag075-B17","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1007\/s00540-022-03140-w","article-title":"Efficacy and indication of fibrinogen replacement therapy in thoracic aortic surgery a retrospective cohort study]","volume":"66","author":"Kikura","year":"2017","journal-title":"Masui"},{"key":"2026032300411167600_ivag075-B18","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/ALN.0b013e3182715d4d","article-title":"Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial","volume":"118","author":"Rahe-Meyer","year":"2013","journal-title":"Anesthesiology"},{"key":"2026032300411167600_ivag075-B19","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1177\/1076029615597061","article-title":"Four-group classification based on fibrinogen level and fibrin polymerization associated with postoperative bleeding in cardiac surgery","volume":"22","author":"Kawashima","year":"2016","journal-title":"Clin Appl Thromb Hemost"},{"key":"2026032300411167600_ivag075-B20","doi-asserted-by":"publisher","first-page":"10760296241254106","DOI":"10.1177\/10760296241254106","article-title":"Long-term safety analysis of a fibrinogen concentrate (RiaSTAP\u00ae\/haemocomplettan\u00aeP)","volume":"30","author":"Rahe-Meyer","year":"2024","journal-title":"Clin Appl Thromb Hemost"},{"key":"2026032300411167600_ivag075-B21","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1213\/ANE.0000000000005513","article-title":"Pro-Con debate: fibrinogen concentrate or cryoprecipitate for treatment of acquired hypofibrinogenemia in cardiac surgical patients","volume":"133","author":"Hensley","year":"2021","journal-title":"Anesth Analg"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag075\/67235025\/ivag075.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/3\/ivag075\/67235025\/ivag075.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/3\/ivag075\/67235025\/ivag075.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T04:41:25Z","timestamp":1774240885000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivag075\/8506516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,12]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag075","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,3]]},"article-number":"ivag075"}}