Semin Thromb Hemost 2020; 46(01): 038-049
DOI: 10.1055/s-0039-1696946
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fibrinogen Supplementation and Its Indications

Oliver Grottke
1  Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
Shuba Mallaiah
2  Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom
Keyvan Karkouti
3  Department of Anesthesia and Pain Management, Sinai Health System, University Health Network and Women's College Hospital, Toronto, Ontario, Canada
Fuat Saner
4  Department of General, Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
Thorsten Haas
5  Department of Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland
› Author Affiliations
Funding Final stage editing was provided by Portland, supported by an unrestricted grant by Octapharma. The sponsor had no influence on the content of this article.
Further Information

Publication History

Publication Date:
01 October 2019 (online)


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.

Authors' Contributions

O. G. contributed to preparing the outline. All authors contributed to the writing of the article, critically reviewing the manuscript, and approving the final version for publication.