There May Not Be a Definite Winner, But Fibrinogen Concentrate is Clearly a Factor to Be Reckoned With

Authors: McNeil JS.; Raphael, J.

Affiliations: Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia.

Publication: Anesthesia and analgesia; 2021; 133. 16–18

Abstract: Acquired hypofibrinogenemia after cardiopulmonary bypass (CPB) is a common phenomenon and is likely an important contributor to the complex coagulopathy inherent in cardiac surgery. Fibrinogen, a hepatically synthesized 340 kDa protein with a normal plasma range of 200 to 400 mg/dL, plays a critical role in achieving effective hemostasis and is the first clotting factor to fall to critically low levels during major bleeding. Maintaining sufficient fibrinogen levels after CPB is crucial for avoiding excessive post-CPB bleeding,1 yet, due to lack of extravascular storage of fibrinogen, the need for fibrinogen supplementation during perioperative bleeding is frequent.