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

Role of Fibrinogen in Hemostasis During Cardiac Surgery

Fibrinogen, which is a plasma glycoprotein that is made in the liver (half-life of ~100 hours), is a critical substrate for thrombin. It catalyzes the conversion of fibrinogen to fibrin and also activates platelets through protease-activated receptors (PARs) 1 and 4 on platelet surfaces. Activation of PARs lead to the release of adenosine diphosphate (ADP) from dense granules and activation of the platelet surface glycoprotein IIb/IIIa receptor, which binds activated platelets to fibrinogen/fibrin.[5,6]

Clot strength is dependent on fibrinogen concentration, and multiple studies have shown that a fibrinogen concentration of >200 mg/dL is necessary for optimal hemostasis in cardiac surgical patients.[3,7] The European guidelines recommend replacing fibrinogen when its concentration is <150 mg/dL in the noncardiac surgical patients.[8] Clot firmness and plasma fibrinogen concentration predictably fall after cardiopulmonary bypass (CPB), mainly due to hemodilution and a lesser degree from consumption.[2] Decreases in clotting factors of 30%–50% are common after CPB and depend on CPB priming volume, retrograde autologous priming (RAP), autologous whole blood collection before CPB, and the amount of cell salvage.[4,9]

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