The clinical use of cryoprecipitate and fibrinogen concentrate: A scoping review

Acquired hypofibrinogenemia poses significant bleeding risks. Concentrated sources of fibrinogen, whether cryoprecipitate or fibrinogen concentrates, are widely used. This scoping review aimed to identify and map the available evidence on fibrinogen supplementation.

We used the JBI Manual and PRISMA-ScR guidelines. We included patients of all ages treated with fibrinogen supplementation. The concept was treatment with cryoprecipitate or fibrinogen concentrate (prophylactically or therapeutically); and context was any clinical setting worldwide. Eligible studies included randomized trials and observational studies with comparator arms. Comprehensive searches of three databases were performed on February 21, 2025. Primary studies meeting inclusion criteria were selected. UpSet data visualizations displayed studies with intersecting sets of characteristics.

From 8181 references screened, 134 met inclusion criteria, of which 61 were randomized trials and 16 propensity-matched observational cohort studies. The highest proportion of trials focused on cardiovascular surgery (28/61; 46%) then trauma (12/61; 20%) populations and mainly assessed use of fibrinogen therapeutically (34/61; 56%). More trials evaluated fibrinogen concentrate (53/61; 87%) compared to cryoprecipitate (8/61; 13%). Commonly reported outcomes included bleeding, transfusion needs, or mortality. Studies inconsistently reported dosing, timing, and definitions of hypofibrinogenemia. Studies evaluating certain key populations-including obstetrics and pediatrics-were limited. All but one propensity-matched study was in either cardiovascular surgery or trauma.

There is a growing body of literature informing use of fibrinogen supplementation, particularly in cardiovascular surgery and trauma populations. Meta-analyses appear feasible to inform evidence-based guideline development; however, variability in dosing, timing, and definitions highlights the need for more harmonized research.