What is the recommended administration rate of fibrinogen (Fibrinogen Concentrate) concentrate?

Recommended Administration Rate of Fibrinogen Concentrate

The recommended maximum administration rate for fibrinogen concentrate is 20 mL per minute for acquired fibrinogen deficiency and 5 mL per minute for congenital fibrinogen deficiency. 1, 2

Administration Guidelines

Dosing

• Initial dose of 3-4 g or 50 mg/kg is recommended for significant bleeding with plasma fibrinogen levels <1.5-2.0 g/L 3
• For surgical prophylaxis, a dose of 25-50 mg/kg is recommended 1
• Higher doses (up to 70 mg/kg) may be required in congenital fibrinogen deficiency 4
• In trauma patients, a median dose of 62.5 mg/kg has been shown to be effective 5

Administration Rate

• Maximum rate of 20 mL per minute for acquired fibrinogen deficiency 1, 2
• Maximum rate of 5 mL per minute for congenital fibrinogen deficiency 1, 2
• No blood should enter the syringe during administration due to risk of fibrin clot formation 1, 2

Monitoring and Repeat Dosing

• Monitor fibrinogen levels before and after administration to guide dosing 1
• Target fibrinogen level should be above 1.5-2.0 g/L for effective hemostasis 3
• In trauma patients, post-treatment fibrinogen levels under 204.5 mg/dL predict the need for massive transfusion 5
• Repeat doses may be guided by thromboelastometric monitoring and laboratory assessment of fibrinogen levels 3
• Additional fibrinogen should not be administered if plasma concentration is over 1.5 g/L without evidence of ongoing bleeding 1

Special Considerations

Pregnancy

• For women with congenital fibrinogen disorders during pregnancy, target a trough fibrinogen level of ≥1 g/L throughout pregnancy 3
• For labor and delivery, maintain fibrinogen levels ≥1.5 g/L 3
• Weekly monitoring of trough fibrinogen levels is recommended in the first month after initiating fibrinogen replacement, then monthly 3

Massive Hemorrhage

• In cases of massive hemorrhage with acquired hypofibrinogenemia, a median dose of 49 mg/kg has been shown to increase fibrinogen levels from 0.9 g/L to 1.8 g/L 6
• For patients with baseline fibrinogen below 100 mg/dL, repeated dosing may be required 5

Potential Adverse Effects

• Monitor for allergic reactions and anaphylaxis, which are potential concerns as with any blood product 1
• Four thrombotic events (three venous and one arterial) were reported in one study of patients treated with fibrinogen concentrate for acquired hypofibrinogenemia 6

Practical Administration Steps

1. Reconstitute fibrinogen concentrate according to manufacturer's instructions 2
2. Inspect the reconstituted solution for particulate matter and discoloration prior to administration 2
3. Use aseptic technique and administer through a separate intravenous line 2
4. Do not administer in the same tubing or container as other medications 2
5. After reconstitution, use immediately or within 4 hours 2
6. Adjust administration rate based on patient comfort and type of fibrinogen deficiency (acquired vs. congenital) 1, 2