Fibrinogen concentrate for acquired hypofibrinogenaemic states

This study aims to assess the efficacy and safety of fibrinogen concentrate in acquired hypofibrinogenaemic states. Cryoprecipitate is standard treatment for replacement of fibrinogen in acquired hypofibrinogenaemia. A virally inactivated fibrinogen concentrate (Haemocomplettan((R)); CSL Behring, Marburg, Germany) is licensed in some European countries. Clinical data for its use in acquired hypofibrinogenaemic states are scarce. Demographic and pretreatment clinical data of patients treated with fibrinogen concentrate for acquired hypofibrinogenaemia were retrospectively reviewed. Pretreatment and posttreatment fibrinogen levels, transfusion requirements, outcomes and adverse events were recorded. Thirty adult patients who received fibrinogen concentrate for acquired hypofibrinogenaemia (fibrinogen < 1.5 g L-1) were included in the study. Causes of hypofibrinogenaemia included placental abruption, disseminated intravascular coagulation as a result of massive blood loss and transfusion, liver failure and cardiac surgery. Following a median dose of 4 g fibrinogen concentrate, median Clauss fibrinogen level rose from 0.65 to 2.01 g L-1, with a median fibrinogen increment of 0.25 g L-1 per 1 g fibrinogen concentrate administered. Forty-six per cent of patients stopped bleeding with blood components and fibrinogen concentrate alone, and a further 29% stopped bleeding with surgical or endoscopic intervention. Inpatient mortality was 40%. No venous thromboses were observed. Four patients with massive perioperative haemorrhage and hypotension (including three postcardiothoracic surgery) had arterial ischaemic events, none of which was attributable to fibrinogen overreplacement. The cost of fibrinogen concentrate was comparable with that of cryoprecipitate. Purified, virally inactivated fibrinogen concentrate appears effective in the management of acquired hypofibrinogenaemic states and enables rapid administration of a known fibrinogen dose in an emergency setting.