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Fibrinogen Supplementation and Its Indications.

Oliver Grottke1, Shuba Mallaiah2, Keyvan Karkouti3

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Seminars in Thrombosis and Hemostasis
|October 2, 2019
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Summary
This summary is machine-generated.

Fibrinogen levels are crucial for blood clotting. Fibrinogen concentrate may be a beneficial option for patients with coagulopathic bleeding, especially when guided by viscoelastic monitoring.

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Area of Science:

  • Hematology
  • Transfusion Medicine
  • Critical Care

Background:

  • Adequate plasma fibrinogen levels are vital for hemostasis.
  • Severe bleeding can lead to critically low fibrinogen concentrations, necessitating supplementation.
  • Fibrinogen concentrate is an alternative to fresh frozen plasma or cryoprecipitate for supplementation.

Purpose of the Study:

  • To review studies on fibrinogen concentrate use in various clinical settings.
  • To evaluate the efficacy and safety of fibrinogen supplementation.
  • To discuss the role of viscoelastic monitoring in guiding fibrinogen therapy.

Main Methods:

  • Systematic review of major studies.
  • Analysis of randomized controlled trials (RCTs) and observational data.
  • Evaluation of fibrinogen concentrate use in trauma, cardiac surgery, liver disease, postpartum hemorrhage, and pediatrics.

Main Results:

  • Some RCTs suggest benefits of fibrinogen concentrate in specific patient groups.
  • Coagulation factor concentrate therapy guided by viscoelastic monitoring (ROTEM/TEG) shows promise.
  • This approach may reduce exposure to allogeneic blood products and associated complications.

Conclusions:

  • Current evidence supports fibrinogen repletion in bleeding patients with deficiency.
  • Fibrinogen concentrate is a viable option, particularly when guided by point-of-care monitoring.
  • Further RCTs are needed to solidify evidence in critical bleeding scenarios.