From the Guidelines
Elevated fibrinogen levels should be treated by addressing the underlying cause, and in cases of major bleeding accompanied by hypofibrinogenemia, treatment with fibrinogen concentrate or cryoprecipitate is recommended, with an initial supplementation of 3-4g, as guided by viscoelastic methods and laboratory assessment of fibrinogen levels 1. Elevated fibrinogen (hyperfibrinogenemia) can be caused by various conditions including:
- Acute and chronic inflammation
- Infections
- Tissue damage
- Malignancies
- Pregnancy
- Obesity
- Smoking
- Certain medications like oral contraceptives Treatment focuses primarily on addressing the underlying cause rather than targeting fibrinogen levels directly. For acute inflammation or infection, treating with appropriate antibiotics or anti-inflammatory medications is essential. For chronic conditions like cardiovascular disease, lifestyle modifications are recommended including:
- Smoking cessation
- Weight loss if overweight
- Regular exercise (30 minutes daily)
- A Mediterranean diet rich in omega-3 fatty acids Medications that may help include statins, which beyond lowering cholesterol can reduce inflammation and fibrinogen levels, and in some cases, antiplatelet therapy like low-dose aspirin (75-100mg daily) may be prescribed for those at cardiovascular risk. Natural supplements with some evidence for reducing fibrinogen include omega-3 fatty acids (1-3g daily), niacin, and nattokinase, though these should be used under medical supervision. Regular monitoring of fibrinogen levels is important for those with persistent elevation, as levels above 350-400 mg/dL are associated with increased cardiovascular risk. Fibrinogen serves as both an inflammatory marker and clotting factor, so elevated levels can indicate ongoing inflammation and increased thrombotic risk, and its administration using viscoelastic methods as guidance may be preferable to measuring fibrinogen levels in the laboratory 1.
From the Research
Causes of Elevated Fibrinogen
- Elevated fibrinogen levels can be associated with an increased risk of pulmonary embolism (PE), but not with deep venous thrombosis (DVT) 2
- Fibrinogen disorders, including afibrinogenemia and hypofibrinogenemia, are defined by the complete absence or reduction of fibrinogen, respectively, and can be caused by homozygosity or combined heterozygosity for the causative mutations 3
- Abnormalities in fibrin(ogen) and fibrinolysis can result in a variety of disorders with hemorrhagic and thrombotic manifestations 4
Treatment of Elevated Fibrinogen
- The main treatment for quantitative fibrinogen disorders is fibrinogen supplementation 3
- Targeting proteins that interact with fibrinogen and which are involved in hypofibrinolysis represents a more specific approach for the development of effective and safe therapeutic agents 5
- Management of surgery and pregnancy in patients with fibrinogen disorders presents significant challenges regarding the amount of fibrinogen replacement and the need for thromboprophylaxis 3
- The use of global fibrinolysis assays can aid in the laboratory evaluation for fibrin(ogen) disorders 4
Fibrinogen and Fibrinolysis
- Fibrinogen plays a fundamental role in coagulation through its support for platelet aggregation and its conversion to fibrin 4, 6
- Fibrin stabilizes clots and serves as a scaffold and immune effector before being broken down by the fibrinolytic system 4, 6
- The physical properties of fibrin clots are determined by structural features at the individual fibrin molecule, fibrin fiber, network, and whole clot levels 6