Efficacy and tolerability of human fibrinogen concentrate administration to patients with acquired fibrinogen deficiency and active or in high‐risk severe bleeding

A, Danes; Cuenca, Lorena; Bueno, Santiago Rodriguez; Barrenechea, Luisa; Ronsano, José Bruno Montoro

doi:10.1111/j.1423-0410.2007.01024.x

Cited by 126 publications

(109 citation statements)

References 22 publications

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“…Additionally, artificial colloids may provoke the generation of false-positive fibrinogen values by optical methods such as the Clauss method [66]. The best and safest treatment option in clinically relevant fibrinogen deficiency is the replacement with fibrinogen concentrate [67,68,69]; the dosage of the fibrinogen concentrate can be calculated as based on the targeted increase in the plasma fibrinogen concentration or clot firmness as determined by the FIBTEMF (ROTEM™) assay, with the extrinsic activation by recombinant tissue factor and the inhibition of platelet function by cytochalasin D (Tem International GmbH) (table 1). For example, a targeted fibrinogen increase by 1 g/l requires the fibrinogen concentrate to be dosed at 50 mg/kg body weight, which results in an 8-mm increase of the MCF pattern measured by FIBTEMF [67,70,71].…”

Section: Management Of Hepatic Coagulopathymentioning

confidence: 99%

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Saner

Gieseler²,

Akız³

et al. 2013

Digestion

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Liver transplantation in cirrhotic patients is accompanied by severe bleeding. Indeed, the first 100 recipients of liver allografts transplanted by Thomas E. Starzl died mainly by uncontrolled bleeding. Since then, much progress has been made as to the understanding of the pathophysiology and the treatment of hemostatic disorders in cirrhotic patients. The aim of this review is to provide a state-of-the-art overview on recent developments and treatment options for hemostatic disorder in cirrhotic patients. Patients with end-stage-liver disease (ESLD) do not suffer only from procoagulant deficiency; there is also a lack of natural anticoagulants (i.e. proteins C and S) and profibrinolytics. Conventional laboratory methods such as the determination of the international normalized ratio or the activated partial thromboplastin time cannot predict bleeding complications in these patients. Progressive diagnostic techniques reveal that cirrhotic patients have the same capacity to produce thrombin like healthy volunteers. Moreover, cirrhotic patients - and particularly those with primary biliary cirrhosis or primary sclerosing cholangitis - are at a higher risk for developing thrombosis as compared with healthy controls. Hemostatic alterations are common in cirrhotic patients; they involve both the pro- and the anticoagulant pathways. However, this is a very delicate balance, which may be shifted to either of these pathways by different treatments thereby causing bleeding or thrombosis, respectively.

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Section: Management Of Hepatic Coagulopathymentioning

confidence: 99%

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Saner

Gieseler²,

Akız³

et al. 2013

Digestion

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“…The mortality rates in patients receiving high amounts of fibrinogen (≥0.2 g from transfused blood products per unit red blood cells) and low amounts of fibrinogen (<0.2 g) were 24% and 52%, respectively (P < 0.001) (5). In central Europe, fibrinogen concentrates and prothrombin complex concentrate (PCC) have been used to treat acquired bleeding complications in surgical and trauma patients with success (6)(7)(8)(9)(10). Although the beneficial effects of fibrinogen on clotting function are indicated in recent literature, the role of fibrinogen on coagulation function in a trauma setting, such as hemorrhage and resuscitation, remains to be clarified.…”

Section: Introductionmentioning

confidence: 99%

Fibrinogen Availability and Coagulation Function after Hemorrhage and Resuscitation in Pigs

Martini

2011

Mol Med

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“…2) wird bei der Dosis zwischen schweren (Konzentration kleiner 1 g/l oder FibTEM < 8 mm) und mittleren Fibrinogenmangelzuständen (Konzentrationen < 1,5 g/l oder FibTEM < 12 mm) unterschieden. Unter Blutungsbedingungen und zur Korrektur eines Fibrinogenmangels wurden bisher keine unerwünschten Wirkungen oder Thrombosen beschrieben [47]. …”

Section: Gerinnungsmanagementunclassified

Intraoperatives Gerinnungsmanagement

Johanning¹

2013

Visc Med

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Hintergrund: Intraoperative Gerinnungsstörungen kommen bei großen Operationen häufig vor und können verschiedene, oft parallel auftretende Ursachen haben. Die Blutungsdynamik unter laufender Operation erfordert eine gute interdisziplinäre Zusammenarbeit sowie ein effektives Team- und Kontextmanagement. Geeignete diagnostische Methoden sind für ein rasches und zielgerichtetes Gerinnungsmanagement notwendig. Methode: Die Literatur bis April 2013 wurde selektiv, inklusive der neuen europäischen und deutschen anästhesiologischen Handlungsempfehlungen zum perioperativen Blutungsmanagement, berücksichtigt. Ergebnisse: Dilutionskoagulopathien zählen zu den häufigsten intraoperativen Gerinnungsstörungen, da bei Blutverlust zur Aufrechterhaltung der Makrozirkulation kolloidale oder kristalloide Lösungen infundiert bzw. Erythrozytenkonzentrate zur Oxygenierung transfundiert werden. Hypothermien, Azidosen, Hypocalciämien, Anämien, Hyperfibrinolysen, Medikamenteneinnahmen und Vorerkrankungen können die Koagulopathien verstärken. Fibrinogen ist der erste Faktor, der bei massiven Blutungen kritisch abfällt und substituiert werden muss. Schlussfolgerungen: Patientennahe diagnostische Verfahren eignen sich besonders zur Differenzierung von intraoperativen Gerinnungsstörungen und einer zielgerichteten Therapie. Faktorenkonzentrate stehen schneller als Gefrierplasmen (fresh frozen plasma, FFP) zur Verfügung und bilden häufig die Basis einer zielgerichteten Therapie. FFP enthalten alle Faktoren in einem physiologischen Verhältnis, allerdings unkonzentriert. Zu den Limitationen zählen neben geringerer Wirksamkeit die zeitaufwendige Vorbereitung und die nicht unerheblichen unerwünschten Wirkungen. Die Evidenzlage ist noch nicht ausreichend für eindeutige Empfehlungen.

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Efficacy and tolerability of human fibrinogen concentrate administration to patients with acquired fibrinogen deficiency and active or in high‐risk severe bleeding

Cited by 126 publications

References 22 publications

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Fibrinogen Availability and Coagulation Function after Hemorrhage and Resuscitation in Pigs

Intraoperatives Gerinnungsmanagement

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