Practice Trends of Fibrinogen Monitoring in Thrombolysis

Abstract

There is a lack of evidence or societal guidelines regarding the utility of fibrinogen monitoring during thrombolysis. The purpose of our study was to investigate the current use of monitoring fibrinogen levels during thrombolysis. A voluntary, anonymous online survey was sent to all physician members of the Society of Interventional Radiology, consisting of 23 questions related to practitioner demographics, thrombolysis protocol, and fibrinogen monitoring. There were 455 physician responses; 82% of respondents monitored fibrinogen levels during thrombolysis, of which 97% decreased or stopped tissue plasminogen activator based on the level. Self-reported estimates of significant bleeding events during thrombolysis were 1.86% in those who monitored fibrinogen and 1.93% in those who did not. Only 34% of all respondents report, in their clinical experience, having found low fibrinogen level to be correlated with bleeding events. There was no significant difference in self-reported major bleeding rates between practitioners who monitor and those who do not monitor fibrinogen. This high variability of clinical use of fibrinogen monitoring during catheter-directed thrombolysis is secondary to the paucity of scientific studies demonstrating its utility; further scientific investigation is needed to define the true utility of fibrinogen monitoring.

Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?

“…The literature, however, is still inconclusive, with studies showing both increased and reduced risk of bleeding at fibrinogen thresholds of less than 150 mg/dl. 19) A meta-analysis of its use in arterial CDT revealed varying protocols for fibrinogen measurement and that its role for predicting haemorrhagic complications after CDT remains unproven because of a limited number of heterogenous studies. 20) There are other modalities for endovascular thrombus removal besides CDT.…”

Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review

“…It should be noted that in a disease entity only several months old, such an approach has no pre-existing controlled trial data and must be considered with extreme caution, although there are now a handful of case reports that so far have demonstrated temporal associations with alteplase administration and improvement of the respiratory status of critically ill patients with COVID-19 (emphasis: a causal relationship in uncontrolled case reports cannot be inferred) 76 (Poor et al, in review; Barrett et al, in review). The large experience using intravenous t-PA for strokes, myocardial infarctions, and pulmonary emboli 66,77,78 may provide a useful guide for its use in COVID-19 respiratory failure in the absence of prior controlled trial data. Our suggestion in such a situation is to consider an initial intravenous bolus dose of 50 or 100 mg of alteplase over 2 hours, concomitant with, or immediately followed by, systemic anticoagulation with heparin.…”

Fibrinolytics for the treatment of pulmonary embolism

“…It is perhaps for this reason that the majority of experts surveyed monitor the fibrinogen concentration during CDT and stop the infusion when fibrinogen levels drop below a prespecified threshold. [33] However, after controlling for infusion dose, the direct evidence between hypofibrinogenemia and bleeding with CDT remains uncertain. [29,34] Taken together, the results of our review do not suggest an evidence-based case to monitor fibrinogen with thrombolytic therapy, regardless of dose or route, but personal preferences are likely to supersede the evidence.…”