title: Fibrinogen supplementation ex vivo increasesclot firmness comparable to platelet transfusion in thrombocytopenia.
abstract: BACKGROUND
  Fibrinogen concentrate can improve clot firmness and offers a better safety profile than platelet concentrates. Reduction or avoidance of blood transfusions represents a strategy to reduce associated risks. We investigated whether supplementation of fibrinogen concentrate ex vivo can compensate for clot strength as compared with platelet transfusion in vivo METHODS: One hundred patients in need of platelet transfusion (PT) were enrolled. Blood samples were collected immediately before PT and at 1 h and 24 h after PT. Fibrinogen concentrate was added to these citrated whole blood samples at concentrations of 50, 100, 200 and 400 mg kg-1and the maximum clot firmness (MCF) was analysed using ROTEM thromboelastometry.
  
  
  RESULTS
  Fibrinogen supplementation increased MCF significantly and dose-dependently before and after PT. The effect of fibrinogen concentrate (equivalent to doses of 100 and 200 mg kg-1) ex vivo was comparable to that of PT in vivo, whereas 400 mg kg-1fibrinogen significantly improved MCF compared with PT (P < 0.001).
  
  
  CONCLUSIONS
  Fibrinogen concentrate can match the effect of PT on MCF in thrombocytopenia. This potential alternative haemostatic intervention should be evaluated in clinical trials.
authors: Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria bettina.schenk@i-med.ac.at.
authors: B
authors: B
authors: Schenk
authors: Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: A K
authors: AK
authors: Lindner
authors: Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: B
authors: B
authors: Treichl
authors: Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: M
authors: M
authors: Bachler
authors: Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: M
authors: M
authors: Hermann
authors: Center for Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Skejby - Brendstrupgårdsvej 100, 8200 Aarhus, Denmark.
authors: O H
authors: OH
authors: Larsen
authors: Center for Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Skejby - Brendstrupgårdsvej 100, 8200 Aarhus, Denmark.|Department of Anaesthesiology, Aarhus University Hospital, Skejby - Brendstrupgårdsvej 100, 8200 Aarhus, Denmark.
authors: C
authors: C
authors: Fenger-Eriksen
authors: Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: D
authors: D
authors: Wally
authors: Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: H
authors: H
authors: Tauber
authors: Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: C
authors: C
authors: Velik-Salchner
authors: Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
authors: D
authors: D
authors: Fries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology*; D001780:Blood Coagulation Tests / Q000379:methods; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D013916:Thrombelastography / Q000379:methods; D013921:Thrombocytopenia / Q000628:therapy*; D055815:Young Adult
chemical_list: D005340:Fibrinogen
keywords: deficiency; fibrinogen; platelet transfusion; thrombocytopenia; thromboelastography