Observational study of fibrinogen concentrate in massive hemorrhage

Abstract

In acute hemorrhage, a critical decrease in fibrinogen often induces acquired coagulopathy. Fibrinogen concentrate has been used to supplement fibrinogen during massive hemorrhage. However, there are limited data on the utilization of fibrinogen concentrate in this setting. This prospective, multicenter observational study analyzed clinical treatment with fibrinogen concentrate in acute bleeding. A prospective multicenter web-based register was developed to document closed cases of massive hemorrhage treated with fibrinogen concentrate perioperatively. Anonymized data including the cause and kinetics of the bleeding, coagulation parameters, coagulation therapy, clinical effects and adverse events were recorded. Two hundred and twenty-three cases entered between September 2008 and August 2009 were eligible for analysis. According to patient needs, additional common blood and coagulation products were administered. Fibrinogen substitution by fibrinogen concentrate and fresh frozen plasma (FFP) was initiated at a median blood loss of 2.0 l and plasma fibrinogen of 1.45 g/l. After a median dose of 12.0 g fibrinogen (4 g in fibrinogen concentrate and 8 g in FFP), plasma fibrinogen rose to 2.19 g/l at the end of surgery; corresponding to a median increment of 0.045 g/l per gram of fibrinogen administered. After substitution, 6% of patients had supra-physiological plasma fibrinogen levels. Three percent of patients sustained thromboembolic complications perioperatively. Logistic regression analysis showed positive correlation of postoperative plasma fibrinogen and survival (P < 0.05). Clinical application of fibrinogen concentrate in bleeding patients is included within a multimodal therapeutic concept. High levels of fibrinogen are necessary in order to reach therapeutic goals. In bleeding patients, higher plasma fibrinogen might be associated with higher rates of survival.

Administration of fibrinogen concentrate in exsanguinating trauma patients is associated with improved survival at 6 hours but not at discharge

“…34 Most other investigations studied FC administration for massive bleeding in miscellaneous populations, with only the minority because of trauma. 27,35,36 In the present study, FC supplementation in bleeding trauma patients was associated with a significantly lower 6-hour mortality and prolonged time to death. Although overall hospital mortality was comparable between the two cohorts, this improvement of early outcome still seems to indicate a favorable effect of acute hemostatic resuscitation.…”

Theoretical modelling of fibrinogen supplementation with therapeutic plasma, cryoprecipitate, or fibrinogen concentrate

“…Another assumption sometimes made is that total fibrinogen dose can be calculated by adding up the quantities of fibrinogen delivered to the patient via different haemostatic agents. 3536 As modelled by FCS amount , the effect of a certain quantity of fibrinogen on plasma fibrinogen level might differ according to the haemostatic agent used. Therefore, calculation of total fibrinogen dose by adding quantities administered via different haemostatic agents may not be meaningful.…”

Albumin and fibrinogen levels′ relation with orthopedics traumatic patients′ outcome after massive transfusion

“…[10] Georg et al .,[11] expressed that higher plasma fibrinogen might be associated with higher rates of survival. [11] According to recent studies, it has been shown that at a fibrinogen level of 150-200 mg/dl, there is already an increased tendency of peri- and postoperative bleeding. [11] A high fibrinogen count exerts a protective effect with regard to the amount of blood loss.…”

“…[11] According to recent studies, it has been shown that at a fibrinogen level of 150-200 mg/dl, there is already an increased tendency of peri- and postoperative bleeding. [11] A high fibrinogen count exerts a protective effect with regard to the amount of blood loss. In multiple trauma patients, priority must be given to early and effective correction of impaired fibrin polymerization by administering fibrinogen concentrate.…”