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withdrawn in many European countries owing to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