From the Literature

 

Published: Oct 2019

Efficacy of fibrinogen concentrate in major abdominal surgery – a prospective, randomized, controlled study in cytoreductive surgery for pseudomyxoma peritonei.
Roy A, Stanford S, Nunn S, et al.
J Thromb Haemost 2019; Oct 26 [Epub ahead of print].
Pub Med
NATA rating :

 

REVIEW by:
J. H. Levy

 

NATA REVIEW:
This European single-centre trial randomised patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei, a procedure associated with significant bleeding. Fibrinogen concentrate (4 g) was compared to cryoprecipitate (10 units) for fibrinogen repletion in a non-inferiority trial that included 43 patients.

Fibrinogen levels were higher in the concentrate treated patients (0.78 vs. 0.35 g/L) and only red blood cells were transfused in either of the groups. Safety was comparable between groups.

One of the theoretical concerns regarding fibrinogen concentrate administration instead of cryoprecipitate was the lack of additional haemostatic factors (e.g., von Willebrand factor, factor XIII, factor VIII). This study evluating a patient population at high risk for bleeding demonstrated no differences in bleeding outcomes.

The use of fibrinogen concentrates was able to reduce allogeneic blood exposure from 10 individual donors. This important finding is consistent with the recently published comparative non-inferiority study of fibrinogen concentrates in high-risk cardiac surgical patients (Callum J et al., JAMA 2019; Oct 21 [Epub ahead of print]).

With the continuing interest in patient blood management, and desire to decrease allogeneic blood exposure in patients, this study adds additional clinical evidence to our ability to replace cryoprecipitate with fibrinogen concentrate for fibrinogen repletion.


– Jerrold H. Levy