Fibrinogen as an Alternative to FFP in Aortic Surgery.
Fibrinogen as an Alternative to FFP in Aortic Surgery.
Thoracoabdominal aneurysm (TAAA) repair is a major elective vascular operation associated
 with a large blood loss and potentially life-threatening clotting abnormalities. Theses
 clotting abnormalities are principally treated using fresh frozen plasma (FFP) (derived from
 human blood donations), the administration of which carries a number of risks including virus
 transmission (human immunodeficiency virus (HIV), hepatitis B, hepatitis C) and infection
 with variant Creutzfeld-Jacob disease (vCJD). FFP is no longer administered to children or
 high-usage adults in the UK because of the infection risk, and recently it was decided by a
 UK advisory body that the use of UK-derived FFP should cease.

 Fibrinogen concentrate is an alternative treatment option to FFP which is thought have less
 infection risk (purified, heat treated) and has been in licensed use for many years in other
 European countries. The investigators have been using fibrinogen concentrate recently in
 their department as an alternative to FFP with encouraging results.

 20 patients undergoing elective TAAA repair at The Royal Infirmary of Edinburgh will be
 randomly allocated to receive standard treatment (FFP) or fibrinogen concentrate as treatment
 for clotting abnormalities during their surgery. The investigators will take a number of
 additional blood samples which will provide valuable information about the pattern of
 clotting abnormalities during this type of operation. The investigators will also record
 blood loss and the number of allogeneic (derived from human donors) blood components
 transfused to the patient (red cells, FFP and platelets). Our primary objective is to assess
 the pattern of coagulation abnormalities in both groups. We will also examine whether the use
 of fibrinogen concentrate during TAAA repair avoids the need to administer FFP.
Inclusion Criteria:

 -  Undergoing elective thoracoabdominal aneurysm repair.

 -  Over 18 years of age.

 -  Able to give written informed consent.

 Exclusion Criteria:

 -  Previous aortic surgery (re-do surgery).

 -  Emergency surgery.

 -  Pregnancy.

 -  Females of child-bearing age (less than 45 years) not using medically approved method
 of contraception.

 -  Congenital or acquired coagulopathy.

 -  Known allergy to study drug.