Therapeutic interventions to lower plasma fibrinogen concentration

Area of Science:

• Cardiovascular Medicine
• Hematology
• Pharmacology

Background:

• A strong causal link exists between elevated plasma fibrinogen and cardiovascular disease (CVD) risk.
• Therapeutic strategies to reduce fibrinogen levels are therefore of significant research interest.

Purpose of the Study:

• To review and evaluate various methods for lowering plasma fibrinogen levels.
• To assess the efficacy and considerations for different fibrinogen-lowering interventions.

Main Methods:

• Literature review of lifestyle modifications, oral medications, and acute interventions affecting fibrinogen.
• Critical analysis of reported data, considering clinical context and risk-benefit profiles.

Main Results:

• Smoking cessation is the most effective lifestyle change; weight reduction, stress management, and physical activity have lesser effects.
• Oral medications like fibrates (e.g., bezafibrate) and ticlopidine show varying degrees of fibrinogen reduction, particularly when levels are elevated.
• Intravenous fibrinolytic agents and extracorporeal LDL precipitation cause dramatic reductions but are rarely used solely for fibrinogen lowering.

Conclusions:

• Multiple interventions can lower plasma fibrinogen, with varying efficacy and applicability.
• Careful consideration of clinical context and risk-benefit analysis is crucial when selecting fibrinogen-lowering therapies.
• The multifaceted effects of these interventions on cardiovascular function complicate the direct testing of fibrinogen's role as an independent CVD risk factor via intervention trials.