Current perspective on fibrinogen concentrate in critical bleeding

Area of Science:

• Critical Care Medicine
• Hematology
• Surgical Hemorrhage Management

Background:

• Massive hemorrhage remains a significant, yet treatable, cause of mortality.
• Current management strategies range from fixed ratio blood component therapy to goal-directed approaches using point-of-care testing and coagulation factor concentrates.

Purpose of the Study:

• To review the current evidence and role of fibrinogen concentrate (FC) in managing massive hemorrhage.
• To evaluate indications, dosage, and adverse effects, particularly thromboembolic events, associated with FC administration.

Main Methods:

• Systematic review of guidelines, meta-analyses, randomized controlled trials, and observational studies.
• Analysis focused on FC use in life-threatening hemorrhage, with or without coagulation testing.
• Inclusion of studies assessing viscoelastic hemostatic assays and plasma fibrinogen levels for guidance.

Main Results:

• Moderate to high-grade evidence supports FC use in severe hemorrhage associated with trauma and cardiac surgery.
• Lower-grade evidence exists for postpartum hemorrhage and end-stage liver disease.
• Preemptive administration in non-bleeding patients is not recommended.

Conclusions:

• FC should be administered early and in a goal-directed manner, guided by specific viscoelastic parameters (A5- or A10-FIBTEM) or low fibrinogen levels.
• Further research is needed on early FC use, its comparison to cryoprecipitate, and risks associated with high-dose administration.