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

Fenger-Eriksen, Christian; Lindberg‐Larsen, Martin; Christensen, Anna-Lisa; Ingerslev, Jørgen; Sørensen, Benny

doi:10.1093/bja/aen270

Cited by 245 publications

(197 citation statements)

References 15 publications

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“…Maintaining fibrinogen levels is an important therapeutic target in bleeding patients, particularly in perioperative settings. [1][2][3] Early studies demonstrated that fibrinogen repletion corrected clot strength, based on viscoelastic blood testing using thromboelastography/thromboelastometry. 4 Normal fibrinogen levels are elevated during pregnancy, 5 and cases studies indicate that fibrinogen repletion may be effective in the treatment of postpartum hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

How I use fibrinogen replacement therapy in acquired bleeding

Levy

Goodnough

2015

Blood

140

102

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Fibrinogen is a critical protein for hemostasis and clot formation. However, transfusion guidelines have variable recommendations for maintaining fibrinogen levels in bleeding patients. An increasing number of studies support the practice of fibrinogen replacement therapy for acquired coagulopathies, and additional studies are underway. Fibrinogen therapy can be administered with cryoprecipitate or fibrinogen concentrates, and clinical practice varies according to their availability and licensing status. Fibrinogen concentrate therapy has been studied in animal models and clinical trials and supports the critical role of fibrinogen repletion in bleeding patients. Point-of-care testing will have an important role in guiding fibrinogen replacement for hemostatic therapy in clinical settings such as cardiovascular surgery, postpartum hemorrhage, and trauma. Fibrinogen therapy is an important component of a multimodal strategy for the treatment of coagulopathic bleeding.

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Section: Introductionmentioning

confidence: 99%

How I use fibrinogen replacement therapy in acquired bleeding

Levy

Goodnough

2015

Blood

140

102

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“…In contrast with fresh frozen plasma, the efficacy of fibrinogen concentrate in the recovery of plasma fibrinogen levels and subsequent hemostasis was reported in hereditary and acquired hypofibrinogenemia,13 including those derived from trauma 14, 15. Encouraged by the volume of pharmacovigilance data showing the safety profile for fibrinogen concentrate,16 off‐label use of the concentrate in Japan to treat massive hemorrhage during aortic surgery17 and obstetrical emergencies has been reported 18.…”

Section: Discussionmentioning

confidence: 99%

Early administration of fibrinogen concentrates improves the short‐term outcomes of severe pelvic fracture patients

Inokuchi

Sawano

Yamamoto

et al. 2017

Acute Medicine & Surgery

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AimHemorrhage from pelvic fracture is a major cause of mortality after blunt trauma. Several studies have suggested that early fibrinogen supplementation improves outcomes of traumatic hemorrhage. Thus, we revised our massive transfusion protocol (MTP) in April 2013 to include early off‐label administration of fibrinogen concentrate. The objective of this study was to evaluate the impact of the revision on the short‐term outcomes of pelvic fracture patients.MethodsThis was a single‐center, retrospective, cohort study. A total of 224 consecutive pelvic fracture patients hospitalized in Saitama Medical Center (Saitama, Japan), 115 before the revision (Group E) and 109 after (Group L), were enrolled. Characteristics of the patients were compared between the groups. Impacts of the revision were evaluated by hazard ratios adjusted for characteristics, injury severity, and coagulation status using Cox's multivariate proportional hazard model. The impact was also evaluated by log–rank test and relative risk of 28‐day mortality between the groups.ResultsThe characteristics were equivalent between the groups. The multivariate analysis revealed that the revision of MTP was significantly related to improved survival with an adjusted hazard ratio (95% confidence interval) of 0.45 (0.07–0.97). The log–rank test gave χ2‐test values of 5.2 (P = 0.022) and 6.7 (P = 0.009), and the relative risks were 0.37 (0.15–0.91) and 0.33 (0.13–0.84), in patients with all Injury Severity Scores and Injury Severity Score ≥21, respectively.ConclusionThe revision of MTP to include aggressive off‐label treatment with fibrinogen concentrate was related to improved short‐term outcomes of severe pelvic fracture patients. However, due to the limitations of the study, the improvement could not be attributed totally to the revision.

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“…Fibrinogen is a coagulation protein produced by the liver that helps the body in the formation of blood clots. The normal range of fibrinogen is 2–4 g/L, but the concentration increases up to threefold in the presence of an inflammatory process, infection, or tissue damage (Fenger‐Eriksen, Lindberg‐Larsen, Christensen, Ingerslev, & Sørensen, 2008; Gruys et al, 2005; Schmaier, 2012). High concentrations of fibrinogen are also strongly associated with chronic obstructive pulmonary diseases and moderately with coronary heart diseases (Danesh et al, 2005; Duvoix et al, 2013; Mannino et al, 2015).…”

Section: Methodsmentioning

confidence: 99%

The health benefits of a targeted cash transfer: The UK Winter Fuel Payment

Crossley

Zilio

2018

Health Economics

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Each year, the UK records 25,000 or more excess winter deaths, primarily among the elderly. A key policy response is the “Winter Fuel Payment” (WFP), a labelled but unconditional cash transfer to households with a member above the female state pension age. The WFP has been shown to raise fuel spending among eligible households. We examine the causal effect of the WFP on health outcomes, including self‐reports of chest infection, measured hypertension, and biomarkers of infection and inflammation. We find a robust, 6 percentage point reduction in the incidence of high levels of serum fibrinogen. Reductions in other disease markers point to health benefits, but the estimated effects are less robust.

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

Abstract: 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.

Cited by 245 publications

References 15 publications

How I use fibrinogen replacement therapy in acquired bleeding

How I use fibrinogen replacement therapy in acquired bleeding

Early administration of fibrinogen concentrates improves the short‐term outcomes of severe pelvic fracture patients

The health benefits of a targeted cash transfer: The UK Winter Fuel Payment

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