HHE Sponsored supplement: Managing perioperative bleed - Page 24

fibrinogen concentrate or cryoprecipitate if significant bleeding is accompanied by thromboelastometric signs of functional fibrinogen deficit or a fibrinogen concentration of <1.5–2 g/l (Grade 1C). 18 Cryoprecipitate, which has been used for fibrinogen supplementation, 23 has been withdrawn in many European countries owing to significant safety concerns. 24 In a small unblinded randomised controlled trial, Curry et al reported that trauma patients receiving cryoprecipitate were able to maintain fibrinogen >1.8g/l at all time points during active bleeding. 23 In some countries in Europe, fibrinogen concentrates have a broad label for congenital and acquired bleeding. 25 In the US, fibrinogen concentrate is licensed for bleeding episodes in 24 HHE 2018 | hospitalhealthcare.com patients with congenital fibrinogen deficiency only. Fibrinogen concentrate does not require thawing or cross-matching and allows rapid administration. 25 High and consistent doses of fibrinogen can be delivered in small volumes. In an emergency setting of major bleeding, injection of 6g in 1–2 minutes has been reported. 26 To guide dosing of fibrinogen concentrate, fibrinogen polymerisation assays, such as FIBTEM or the functional fibrinogen test, are beneficial. 27 Potential compensatory effect of fibrinogen on low platelet count Severe ongoing blood loss results not only in depletion of coagulation proteins but also in a critical drop in platelets. 28 Data from animal studies revealed that high fibrinogen levels might