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: Dose Predictability

FDA-approved fibrinogen concentrates contain a standardized concentration of fibrinogen (Table 1). The 2 fibrinogen concentrates approved for the treatment of congenital hypofibrinogenemia in the United States are RiaSTAP (CSL Behring, King of Prussia, PA), which has a fibrinogen concentration of 900–1300 mg/vial (~1000 mg); and FIBRYGA (Octapharma USA, Paramus, NJ), which has a fibrinogen concentration of 1000 mg/vial.[21,22] Previous studies have demonstrated a significant variation in the fibrinogen content of cryoprecipitate, which ranges from 120 to 796 mg per individual unit.[23–26] This variability may lead to an inconsistent hemostatic efficacy for cryoprecipitate. Alternatively, fibrinogen concentrate has a known fibrinogen content, leading to predictable effects. The following formula can be used to find the dose fibrinogen concentrate.

Dose of fibrinogen concentrate (mg) = Target plasma concentration (mg/dL) − Measured plasma concentration (mg/dL)/1.7 × body weight (kg).

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