Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

Golden hour for fibrinogen concentrate infusion to improve post partum hemorrhage

“…Previous studies have suggested prophylactic fibrinogen transfusion to prevent PPH, while others denied its benefit [5]. However, according to our experience, the first hour following severe PPH (golden hour) seems to be the best timing for fibrinogen concentrate infusion to reduce the blood loss, transfusion requirements and surgical hemostasis.…”

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

“…Implementation of FIBTEM-guided fibrinogen substitution in bleeding management algorithms during liver transplantation significantly reduced transfusion requirements for red blood cells, plasma, and platelets [31,92,97,101,[114][115][116][117][118]. In contrast, preemptive administration of fibrinogen concentrate did not influence transfusion requirements in an RCT in liver transplantation [119].…”

Correlation between plasma fibrinogen and FIBTEM thromboelastometry during liver transplantation: a comprehensive assessment

“…Notably, no additional benefit was observed in terms of RBC requirements with FIBTEM MCF values above 10 mm, which was the cut‐off beyond which fibrinogen administration may be futile and, indeed, exposes the patient to the potential undesirable effects of this drug. In the light of our previous results (the pre‐emptive administration of fibrinogen did not influence transfusion requirements ), and bearing in mind that LT is a dynamic procedure, administration of fibrinogen to maintain FIBTEM MCF above 8 mm, in case of if the patient is bleeding or it is expected to bleed, would be a more suitable approach for reducing transfusion requirement than prophylactic administration of fibrinogen.…”

“…In our previous study , we found that the administration of 3·54 g of fibrinogen (95% CI 2·95‐4·14) produced a mean increase in plasma fibrinogen of 0·32 g/l (95% CI 0·13–0·51) and a mean increase in FIBTEM A10 of 3·77 mm. These values contrast with the studies of Solomon and colleagues in patients with extracorporeal circulation, which showed higher increases in both parameters .…”