Fibrinogen/prothrombin-complex-concentrate

Abstract

Thrombosis: case report A 43-year-old man developed thrombosis following treatment with fibrinogen and prothrombin-complex-concentrate. The man with advanced silicosis underwent left lung transplantation under venovenous extracorporeal membrane oxygenation (VV-ECMO). The ECMO catheter was inserted via the right internal jugular vein. During the procedure, a large amount of blood oozed from the wound surface and 10,500mL of blood was lost. Intraoperatively, he was administered autologous blood, red blood cells, plasma, cryoprecipitate, and platelets. In addition, he also received fibrinogen 3g [Human fibrinogen] infusion and prothrombin-complex-concentrate 800U [Prothrombin complex] infusion within 32 minutes [routes not stated]. Postoperatively, the ECMO speed was 3000 r/min and the flow rate was 3.6 L/min. Thereafter, he received anticoagulant therapy with heparin to maintain activated partial thromboplastin time. Prior to ECMO weaning an ultrasonography revealed an ECMO lumen abnormality. Thus, he was removed from the VV-ECMO machine. Six hours after ECMO withdrawal, thrombosis from the right external iliac vein to the inferior vena cava was found in the shape of the ECMO pipe. The development of thrombosis was attributed to fibrinogen and prothrombin-complex-concentrate therapy. The man was treated with heparin as an anticoagulant therapy which did not affect the size of the thrombus. Two weeks later, he developed a severe infection and died due to multiple organ failure a week after discharge.