From the Guidelines
For a bleeding patient, the fibrinogen level should be maintained at or above 2.0 g/L, as levels below this threshold are associated with increased risk of severe bleeding and poor outcomes, as suggested by studies such as 1. When managing a bleeding patient, it is crucial to prioritize maintaining adequate fibrinogen levels to ensure effective clot formation and hemostasis. Some key points to consider in the management of bleeding and fibrinogen levels include:
- Fibrinogen is a critical component of blood coagulation, and its depletion can lead to impaired clot formation and stability, as noted in 1.
- During massive bleeding, fibrinogen may be the first coagulation factor to decrease critically, highlighting the need for prompt replacement, as discussed in 1.
- Fibrinogen treatment, such as with fibrinogen concentrate, can help reduce the need for allogeneic blood product transfusion and improve outcomes in patients with serious perioperative bleeding, as shown in 1.
- The use of cryoprecipitate or fibrinogen concentrate for replacement is recommended, with dosing guided by the patient's weight and fibrinogen level, as suggested by 1.
- Reassessment of fibrinogen levels after replacement is essential to ensure adequate correction and optimal patient outcomes. In clinical practice, maintaining a fibrinogen level at or above 2.0 g/L is a reasonable target, particularly in patients with trauma or obstetric hemorrhage, where higher target levels may be recommended to ensure robust clot formation, as implied by 1.
From the Research
Fibrinogen Levels in Bleeding Patients
- Normal plasma fibrinogen levels range from 2.0 to 4.5 g/L 2
- Current guidelines recommend maintaining the plasma fibrinogen level above 1.5 g/L 2
- Fibrinogen is the first coagulation factor to fall to critically low levels (<1.0 g/L) during major hemorrhage 2
Treatment of Coagulopathic Bleeding
- Fibrinogen concentrate provides a promising alternative to allogeneic blood products and has a number of advantages, including a standardized dose, rapid administration, and a good safety profile 2
- Administration of fibrinogen concentrate, often guided by point-of-care viscoelastic testing, has been successfully used as hemostatic therapy in a range of clinical settings, including cardiovascular surgery, postpartum hemorrhage, and trauma 2
- The use of fibrinogen concentrate, prothrombin complex concentrate, and recombinant-activated factor VIIa may be more effective and safer than transfusion of allogeneic blood products in the treatment of coagulopathic bleeding 3
Fibrinogen Supplementation
- Fibrinogen supplementation can be achieved using plasma or cryoprecipitate, but there are safety concerns associated with these allogeneic blood products 2
- Fibrinogen concentrate is associated with a reduction or even total avoidance of allogeneic blood product transfusion 2
- The combination of fibrinogen with tranexamic acid and prothrombin complex with tranexamic acid may have a higher effect on clot strength and fibrinolysis inhibition than using these agents alone 4