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

Cryoprecipitate Disadvantage: Inferior Safety Profile Compared to Fibrinogen Concentrate

The risk of pathogen transmission is one of the primary reasons that cryoprecipitate was removed from European markets. Similar to other allogeneic blood products, cryoprecipitate undergoes nucleic acid testing for HIV, hepatitis B, and hepatitis C. Yet, it does not undergo viral inactivation, as it occurs with fibrinogen concentrate. Over 10,000 men with hemophilia were infected with HIV through blood transfusion in the United States before universal HIV screening began. Although the direct acquisition cost for fibrinogen concentrate is higher in the United States, this type of analysis does not take into account the cost associated with pathogen transmission.[45] It is important to note that as Europe withdrew cryoprecipitate from its markets 15 years ago, it has not reversed course based on the new information. After the FIBRES study, Health Canada also approved fibrinogen concentrate to treat acquired hypofibrinogenemia.

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