Administration of fibrinogen concentrate for refractory bleeding in massively transfused, non-trauma patients with coagulopathy: a retrospective study with comparator group.

Leal-Noval SR, Casado M, Arellano-Orden V, et al.
BMC Anesthesiol 2014;14:109.
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Review by : O. Habler
NATA Review

Compensation of blood losses with infusion of crystalloidal and/or colloidal infusion solutions results in dilution of all circulating blood components. The first coagulation factor falling below its lower acceptable level (<1.5 g/L) is plasma fibrinogen. Therefore, from the theoretical point of view, fibrinogen should be substituted early during an ongoing major blood loss and fibrinogen concentrate should be preferred over fresh frozen plasma. Unfortunately, high-quality RCT data proving the efficacy of fibrinogen concentrate administration in reducing blood loss, transfusion requirements and patient morbidity/mortality are still awaited. In this retrospective single-centre study in 143 patients having experienced massive non-traumatic bleeding (transfusion of ≥4 units of allogeneic blood components within ≤4 hours), late administration of low-dose (2 g) fibrinogen concentrate (after 5 units of allogeneic blood components or 3 hours after initiation of the massive transfusion protocol) neither improved plasma fibrinogen concentration nor reduced allogeneic transfusion and mortality. In a multivariate regression analysis, low fibrinogen levels upon admission could be identified as independently associated with the total number of allogeneic blood components transfused. The authors conclude that both earlier administration and higher doses of fibrinogen concentrate could improve its efficacy in massively transfused patients. – Oliver Habler
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