National audit of the use of fibrinogen concentrate to correct hypofibrinogenaemia.
BACKGROUND
Massive haemorrhage occurs in a variety of clinical settings resulting in consumptive and dilutional coagulopathies leading to hypofibrinogenaemia.


METHODS
A prospective observational national cohort study was performed between November 2008 and June 2010 to collect safety data on the off-label use of a fibrinogen concentrate to treat acquired hypofibrinogenaemia.


RESULTS
A prospective cohort of 63 patients with varying causes of hypofibrinogenaemia resulted from this data collection. A single infusion of fibrinogen concentrate was given in 49 (77%) of patients studied and 12 received more than one infusion. The median inter-quartile range (IQR) dose of fibrinogen infused was 49 (26-61) mg kg(-1). The median (IQR) fibrinogen level before and after infusion was 0.9 (0.6-1.3) and 1.8 (1.4-4.3) g L(-1), respectively (P < 0.001). In 31 patients (67%), bleeding stopped within 4 h and fibrinogen was reported to have contributed to this outcome by the treating clinicians. In 84% of cases the treating clinician reported that the use of fibrinogen concentrate reduced the rate of bleeding. Fibrinogen was associated with a statistically significant reduction in red blood cell transfusion (median 4 units before and 0 units after, P < 0.001) and fresh frozen plasma infusion (median 4 units before and 0 units after, P < 0.001). Three venous and one arterial non-fatal thrombotic events were recorded in the patients treated with fibrinogen.


CONCLUSIONS
Fibrinogen concentrate can be used to correct hypofibrinogenaemia and may reduce blood product usage.
The School of Medicine, University Hospital of Wales and School of Medicine, Cardiff University Cardiff, UK.
N D
ND
Gollop
J
J
Chilcott
A
A
Benton
R
R
Rayment
J
J
Jones
P W
PW
Collins
D000293:Adolescent; D000328:Adult; D000347:Afibrinogenemia / Q000097:blood / Q000188:drug therapy*; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003029:Coagulants / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D006113:United Kingdom
D003029:Coagulants; D005340:Fibrinogen