Current perspective on fibrinogen concentrate in critical bleeding

Authors: Leal-Noval, SR, Fernandez, PJ, Casado, MM, Cuenca-Apolo, D, and Munoz-Gomez, M.

Publication: Expert Rev.Clin Pharmacol.;

Affiliations: Neuro Critical Care department. University Hospital « Virgen del Rocío » and Institute of Biomedicine « IBIS », Avda Manuel Siurot s/n, 41013, Seville, Spain; Pharmacy and Statistics and Design, University Hospital « Virgen del Rocío »; Critical Care department; University Hospital « Virgen del Rocío »; Department of Surgical Specialties, Biochemistry and Immunology, University of Málaga, Campus Teatinos s/n, 29071, Málaga, Spain.

Abstract: INTRODUCTION: Massive hemorrhage continues to be a treatable cause of death. Its management varies from prefixed ratio-driven administration of blood components to goal-directed therapy based on point-of-care testing and administration of coagulation factor concentrates. AREAS COVERED: We review the current role of fibrinogen concentrate (FC) for the management of massive hemorrhage, either administered without coagulation testing in life-threatening hemorrhage, or within an algorithm based on viscoelastic hemostatic assays and plasma fibrinogen level. We identified relevant guidelines, meta-analyses, randomized controlled trials, and observational studies that included indications, dosage, and adverse effects of FC, especially thromboembolic events. EXPERT OPINION: Moderate- to high-grade evidence supports the use of FC for the treatment of severe hemorrhage in trauma and cardiac surgery; a lower grade of evidence is available for its use in postpartum hemorrhage and end-stage liver disease. Pre-emptive FC administration in non-bleeding patients is not recommended. FC should be administered early, and in a goal-directed manner, guided by early amplitude of clot firmness parameters (A5- or A10-FIBTEM) or hypofibrinogenemia. Further investigation is required into the early use of FC, as well as its potential advantages over cryoprecipitate, and whether or not its administration at high doses leads to a greater risk of adverse events.