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


Anesth Analg. 2021;133(1):19-28. 

In This Article


Whether to use fibrinogen concentrate or cryoprecipitate as a first-line therapy for the treatment of acquired hypofibrinogenemia in the cardiac surgical patients continues to be a subject of intense debate in the United States. Fibrinogen concentrate has many potential advantages including a rapid administration, the predictability of dose response, and a lower risk for viral transmission, which aligns well with the FDA's recommendation to use pathogen-reduced blood products when feasible.[62] However, fibrinogen concentrate's lack of VWF, factor VIII, factor XIII, and fibronectin may reduce its hemostatic efficacy, particularly in cases with long CPB duration, in aortic stenosis patients, and in ECMO and left ventricular assist device (LVAD) patients. Fibrinogen concentrate's higher cost and lack of regulatory approval for treating acquired hypofibrinogenemia continue to be significant impediments to more widespread use in the United States despite widespread use in Canada and Europe. Furthermore, evidence supporting the routine or prophylactic use of fibrinogen concentrate in the cardiac surgical patients is not robust, and larger studies are needed to confirm its value compared to cryoprecipitate, which has been the gold standard for treating acquired hypofibrinogenemia for almost 50 years.