Abstract
Adequate plasma levels of fibrinogen are essential for clot formation, and in severe
bleeding, fibrinogen reaches a critically low plasma concentration earlier than other
coagulation factors. Although the critical minimum concentration of fibrinogen to
maintain hemostasis is a matter of debate, many patients with coagulopathic bleeding
require fibrinogen supplementation. Among the treatment options for fibrinogen supplementation,
fibrinogen concentrate may be viewed by some as preferable to fresh frozen plasma
or cryoprecipitate. The authors review major studies that have assessed fibrinogen
treatment in trauma, cardiac surgery, end-stage liver disease, postpartum hemorrhage,
and pediatric patients. Some but not all randomized controlled trials have shown that
fibrinogen concentrate can be beneficial in these settings. The use of fibrinogen
as part of coagulation factor concentrate based therapy guided by point-of-care viscoelastic
coagulation monitoring (ROTEM [rotational thromboelastometry] or TEG [thromboelastography])
appears promising. In addition to reducing patients' exposure to allogeneic blood
products, this strategy may reduce the risk of complications such as transfusion-associated
circulatory overload, transfusion-related acute lung injury, and thromboembolic adverse
events. Randomized controlled trials are challenging to perform in patients with critical
bleeding, and more evidence is needed in this setting. However, current scientific
rationale and clinical data support fibrinogen repletion in patients with ongoing
bleeding and confirmed fibrinogen deficiency.
Keywords
coagulopathy - fibrinogen - hemorrhage - perioperative
