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

Fibrinogen Concentrate Advantage: Lower Thromboembolic Risk

Because cryoprecipitate is not a purified product and contains platelet microparticles, fibronectin, Factor VIII, and VWF, there may be an increased thromboembolic risk. Solomon et al's[43] pharmacovigilance evaluation of fibrinogen concentrate over a 27-year period specifically analyzed the risk of thromboembolism. In this study, the authors identified 28 possible cases of thromboembolism in >600,000 administered doses of fibrinogen concentrate. This extrapolates to ~1 thromboembolic event per 23,300 doses of 4 g of fibrinogen concentrate or an absolute risk of 0.004%. The FIBRES study reported a 2.6% higher thromboembolism rate in patients who received cryoprecipitate at 9.6% compared to 7.0% in patients who received fibrinogen concentrate (Table 1); however, this difference was not statistically different.[24]

Another randomized controlled trial, which included patients with pseudomyxoma peritonei and cytoreductive surgery, found a higher incidence of thromboembolic events in the cryoprecipitate group at 30.4% (7 of 23) compared to 0% (0 of 22) in the fibrinogen concentrate group.[44] In a recent systematic review of randomized controlled trials examining fibrinogen concentrate, the authors concluded that the overall risk of thromboembolism is probably extremely low, and no studies reported a significantly increased risk of thromboembolism in patients receiving fibrinogen concentrate.[20]

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