National audit of the use of fibrinogen concentrate to correct hypofibrinogenaemia

Gollop, Nicholas D.; Chilcott, James; Benton, Ann; Rayment, Rachel; Jones, Jerry L.; Collins, P.

doi:10.1111/j.1365-3148.2012.01168.x

Cited by 30 publications

(21 citation statements)

References 23 publications

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“…Although a few case series have been reported previously17, there are no controlled studies of the efficacy and complications of fibrinogen concentrate usage in patients with massive obstetric haemorrhage and hypofibrinogenaemia9101112131415. Only one study included a control group; however, this study compared the use of cryoprecipitate and fibrinogen concentrate rather that comparing the use and non-use of fibrinogen concentrate18.…”

Section: Discussionmentioning

confidence: 99%

“…The use of fibrinogen and other coagulation factor concentrates that include high levels of fibrinogen should therefore provide therapeutic benefits by efficiently restoring the levels of key coagulation factors. However, there are few studies comparing the efficacy of these blood products in obstetric patients with that of a relevant control group91011121314, and no reports have investigated this in a controlled clinical setting in individuals with hypofibrinogenaemia15 because these are generally emergency medicine patients. Therefore, in the present study we retrospectively compared the effects of administering a fibrinogen concentrate to patients treated for hypofibrinogenaemia (fibrinogen < 150 mg/dl) attributable to massive obstetric haemorrhage with those observed in patients treated with FFP alone, including reduced complications.…”

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confidence: 99%

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The Clinical Efficacy of Fibrinogen Concentrate in Massive Obstetric Haemorrhage with Hypofibrinogenaemia

Matsunaga

Takai

Era

et al. 2017

Sci Rep

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Massive obstetric haemorrhage remains a major cause of maternal death attributable to hypofibrinogenaemia. Transfusion of large volumes of fresh frozen plasma (FFP) is required to normalise fibrinogen levels. We compared the efficacy of FFP (F group) with that of FFP plus fibrinogen concentrate (F + F group) in massive obstetric haemorrhage. In this retrospective study, we compared the medical charts (2004–2016) of 137 patients with <150 mg/dl fibrinogen treated with F + F (n = 47; after August 2009) or F (n = 56; before August 2009). Although fibrinogen concentrate was only administered in severe cases, the FFP/red blood cell concentrate (RCC) ratio was significantly lower in the F + F group than in the F group. A sub-group analysis of cases requiring ≥18 RCC units showed that the F + F group received significantly less FFP than the F group (40.2 ± 19.6 versus 53.4 ± 18.5 units; P = 0.047) and showed significantly less pulmonary oedema (24.0% vs 57.1%; P < 0.05) in the absence of any significant differences in pre-transfusion coagulation, estimated blood loss, or RCC transfusion volume. Administration of fibrinogen concentrate increased the rate of fibrinogen supplementation five-fold and reduced FFP dosage, the FFP/RCC ratio, and the incidence of pulmonary oedema.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Clinical Efficacy of Fibrinogen Concentrate in Massive Obstetric Haemorrhage with Hypofibrinogenaemia

Matsunaga

Takai

Era

et al. 2017

Sci Rep

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“…Anecdotal, uncontrolled reports suggest improved hemostasis associated with increasing fibrinogen levels. [31][32][33][34][35] It is not known whether a low fibrinogen or fibrin-based clot formation causes progression of PPH or reflects the severity of the bleed. There is biological plausibility to support causality, because these factors are critical for clot formation.…”

Section: (27)mentioning

confidence: 99%

Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study

Collins

Lilley

Bruynseels

et al. 2014

Blood

215

228

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“…The literature consists of case reports and series of women with significant hypofibrinogenaemia. It is easy to mix and administer in an acute situation, which has made it popular in some centres, and anecdotal, uncontrolled studies report improved clinical haemostasis associated with increased fibrinogen levels [43,[46][47][48][49]. Increasing the fibrinogen level by 1 g.l…”

Section: Fibrinogen Concentratementioning

confidence: 99%

Haemostatic management of obstetric haemorrhage

2014

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SummaryThe haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non-pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point-of-care monitoring of coagulation abnormalities, and the potential to give goal-directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause. This review examines areas such as possible intervention points, describes evidence for overtransfusion of fresh frozen plasma in some situations and challenges conventional thinking on formulaic management. It also examines the rationale for other therapeutic options, including fibrinogen concentrate and tranexamic acid.

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National audit of the use of fibrinogen concentrate to correct hypofibrinogenaemia

Abstract: Fibrinogen concentrate can be used to correct hypofibrinogenaemia and may reduce blood product usage.

Cited by 30 publications

References 23 publications

The Clinical Efficacy of Fibrinogen Concentrate in Massive Obstetric Haemorrhage with Hypofibrinogenaemia

The Clinical Efficacy of Fibrinogen Concentrate in Massive Obstetric Haemorrhage with Hypofibrinogenaemia

Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study

Haemostatic management of obstetric haemorrhage

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