Pro-Con Debate

Fibrinogen Concentrate or Cryoprecipitate for Treatment of Acquired Hypofibrinogenemia in Cardiac Surgical Patients

Nadia B. Hensley, MD; Michael A. Mazzeffi, MD, MPH, MSc, FASA

Disclosures

Anesth Analg. 2021;133(1):19-28. 

In This Article

Abstract and Introduction

Abstract

Cryoprecipitate has been the gold standard for treating acquired hypofibrinogenemia in cardiac surgery for nearly 50 years. More recently, fibrinogen concentrate has been used off-label in the United States and is the standard in European countries and Canada to treat the acquired hypofibrinogenemia during cardiac surgery. Fibrinogen concentrate has multiple potential advantages including rapid reconstitution, greater dose predictability, viral inactivation during processing, and reduced transfusion-related adverse events. However, because fibrinogen concentrate lacks the other components contained in the cryoprecipitate, it may not be the "ideal" product for replacing fibrinogen in all cardiac surgical patients, particularly those with longer cardiopulmonary bypass duration. In this Pro-Con commentary article, we discuss the advantages and disadvantages of using fibrinogen concentrate and cryoprecipitate to treat acquired hypofibrinogenemia in cardiac surgical patients.

Introduction

Ten to 15% of the United States blood supply is transfused in cardiac surgical patients.[1] Multiple factors including fibrinogen concentration impact bleeding and transfusion risk in cardiac surgical patients.[2–4] About 15 years ago, most European countries removed cryoprecipitate from their markets and began to use fibrinogen concentrate for the treatment of acquired hypofibrinogenemia, mainly because of its superior safety profile. Although fibrinogen concentrate is now extensively used in Europe and Canada, there remains debate in the United States about whether a fibrinogen concentrate is superior when compared to a cryoprecipitate for treating acquired hypofibrinogenemia in the cardiac surgical patients. In this Pro-Con commentary article, we discuss the advantages and disadvantages of both products for treating acquired hypofibrinogenemia in the cardiac surgical patients.

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