From the Guidelines
The patient with a fibrinogen level of 70 mg/dL should be treated with fibrinogen concentrate or cryoprecipitate to prevent or treat bleeding, as their fibrinogen level is below the recommended threshold of 100-150 mg/dL. Management of hypofibrinogenemia focuses on replacing fibrinogen to prevent or treat bleeding. The primary treatment is fibrinogen concentrate (RiaSTAP, Fibryga) administered at 70-100 mg/kg intravenously, with dosing adjusted based on fibrinogen levels and clinical response, as suggested by 1. Cryoprecipitate (10-15 mL/kg or 1 unit per 5-10 kg) can be used as an alternative when concentrate is unavailable.
Key Considerations
- Treatment is typically initiated when fibrinogen levels fall below 100-150 mg/dL or when bleeding occurs, as indicated by 1.
- For patients with congenital hypofibrinogenemia, prophylactic therapy may be necessary before surgeries or invasive procedures, aiming to maintain fibrinogen levels above 100 mg/dL.
- In acquired cases, addressing the underlying cause (such as DIC, liver disease, or massive hemorrhage) is essential alongside fibrinogen replacement, as noted in 1.
- Antifibrinolytic agents like tranexamic acid (10-15 mg/kg IV every 8 hours) may be added as adjunctive therapy to stabilize clots.
- Regular monitoring of fibrinogen levels is crucial to guide dosing and assess treatment efficacy, with the goal of maintaining levels sufficient to prevent bleeding complications.
Treatment Options
- Fibrinogen concentrate: 70-100 mg/kg intravenously, with dosing adjusted based on fibrinogen levels and clinical response.
- Cryoprecipitate: 10-15 mL/kg or 1 unit per 5-10 kg, as an alternative when concentrate is unavailable.
Important Considerations
- The patient's fibrinogen level is below the recommended threshold, indicating the need for treatment to prevent or treat bleeding, as suggested by 1.
- The choice of treatment should be based on the patient's individual needs and the availability of treatment options, with consideration of the guidelines provided by 1 and 1.
From the Research
Management of Hypofibrinogenemia
The management of a patient with hypofibrinogenemia, characterized by a fibrinogen level of 70, involves replacement therapy to prevent or treat bleeding episodes.
- Replacement therapy is the mainstay of treatment, with plasma-derived fibrinogen concentrate being the agent of choice 2.
- Fibrinogen concentrate has been shown to reduce bleeding and transfusion requirements in patients with hypofibrinogenemia 3, 4.
- The use of fibrinogen concentrate is supported by studies demonstrating its efficacy and safety in correcting perioperative bleeding-associated hypofibrinogenemia in adults 5.
Treatment Options
Alternative treatment options include:
- Cryoprecipitate, which can be used when fibrinogen concentrate is not available 2.
- Fresh frozen plasma, which can also be used as an alternative to fibrinogen concentrate 2.
- However, cryoprecipitate is no longer considered the best therapeutic choice due to the availability of pathogen-reduced fibrinogen concentrates, which have a lower risk of viral transmission and standardized fibrinogen content 6.
Administration and Dosage
- The administration and dosage of fibrinogen concentrate should be individualized based on the patient's condition and laboratory results, such as fibrin-based thromboelastometry tests 4.
- The average dosage of fibrinogen concentrate administered in one study was 2.7 g, with a pre-operative fibrinogen level averaging 161 mg/dL 5.