Evidence for Fibrinogen Replacement in Cardiac Surgical Patients With Acquired Hypofibrinogenemia
Lyophilized, pooled fibrinogen concentrate has emerged as an alternative source of fibrinogen for the cardiac surgical patients with acquired hypofibrinogenemia. Fibrinogen concentrate has several potential advantages over cryoprecipitate, but there are also potential disadvantages. Given the increased emphasis that has been placed on reducing allogeneic transfusion in the cardiac surgical patients, the advantages and disadvantages of using fibrinogen concentrate or cryoprecipitate to treat acquired hypofibrinogenemia in the cardiac surgical patients must be considered.
In vitro and observational studies have demonstrated the importance of fibrinogen replacement for adequate hemostasis, yet randomized controlled trials of fibrinogen treatment compared to placebo have not shown a mortality benefit. Cushing and Haas examined these clinical trials and determined that fibrinogen's inconsistent efficacy may be related to design flaws in the trials themselves, including variable definitions for hypofibrinogenemia, inclusion of patients with insignificant bleeding, and off-protocol interventions.
Anesth Analg. 2021;133(1):19-28. © 2021 International Anesthesia Research Society