Fibrinogen concentrate substitution therapy in patients with massive haemorrhage and low plasma fibrinogen concentrations

C Fenger-Eriksen, M Lindberg-Larsen, A Q Christensen, J Ingerslev, B Sørensen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Patients experiencing massive haemorrhage are at high risk of developing coagulopathy through loss, consumption, and dilution of coagulation factors and platelets. It has been reported that plasma fibrinogen concentrations may reach a critical low level relatively early during bleeding, calling for replacement fibrinogen therapy. Cryoprecipitate has been widely used in the past, but more recently, a pasteurized fibrinogen concentrate has become available. We audited the effects of fibrinogen concentrate therapy on laboratory and clinical outcome in patients with massive haemorrhage.

METHODS: We identified 43 patients over the previous 2 yr to whom a fibrinogen concentrate had been administered as treatment for hypofibrinogenaemia during serious haemorrhage. Platelet count, P-fibrinogen, activated partial thromboplastin time (APTT), prothrombin time (PT), D-dimer, and volume of blood lost were obtained from medical and laboratory records. Numbers of units of red blood cells (RBC), fresh frozen plasma (FFP), and pooled platelet concentrates were recorded before and after fibrinogen substitution.

RESULTS: A significant increase in plasma fibrinogen concentration was observed after fibrinogen concentrate therapy. Platelet counts and fibrin D-dimer values remained unchanged, whereas the APTT and PT improved significantly. Requirements for RBC, FFP, and platelets were significantly reduced. Blood loss decreased significantly.

CONCLUSIONS: Off-label substitution therapy with a fibrinogen concentrate generally improved global laboratory coagulation results and as supplementary intervention, appeared to diminish the requirements for RBC, FFP, and platelet substitution in this patient cohort.

Original languageEnglish
JournalBritish Journal of Anaesthesia
Volume101
Issue number6
Pages (from-to)769-73
Number of pages5
ISSN0007-0912
DOIs
Publication statusPublished - Dec 2008

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Keywords

  • Adolescent
  • Adult
  • Afibrinogenemia/blood
  • Aged
  • Blood Component Transfusion
  • Blood Loss, Surgical/prevention & control
  • Child
  • Child, Preschool
  • Female
  • Fibrinogen/metabolism
  • Hemorrhage/blood
  • Hemostasis, Surgical/methods
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Platelet Count
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

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