Abstract
BackgroundThis retrospective, single centre study was conducted to investigate the efficacy of fibrinogen concentrate (FBNc) in decreasing blood requirements and reaching optimal fibrinogen level, in non-trauma, massively transfused, bleeding patients with coagulopathy.MethodsOver a 3-years period, all patients for whom a massive transfusion protocol was activated and had received ≥4 units of allogeneic blood components within a ≤4 h period, were included. Patients were classified according to whether they received FBNc or achieved an optimal fibrinogen level of ≥2 g/L within 24 h after FBNc administration.ResultsSeventy-one patients received 2 [2,4] g of FBNc (FBNc group) and 72 did not (comparator group). FBNc was administered after transfusing 5 [5,9] blood component units, 3 [2,6] hours after massive transfusion protocol activation. Linear regression analysis showed that SOFA (AOR 0.75 [95% CI:0.08-1.43]) and admission fibrinogen level (AOR -2.7 [95% CI:-4.68 – -0.78]), but not FBNc administration, were independently associated with total transfused units. There was a significant inverse relation between both admission and target fibrinogen levels, and total transfused components. Logistic regression showed a direct relationship between admission fibrinogen level and achieving a target level ≥2 g/L (AOR 3.29 [95% CI;1.95-5.56]). No thromboembolic events associated with FBNc were observed.ConclusionsIn massively transfused, non-trauma patients with coagulopathy and refractory bleeding, late administration of low FBNc dosage was not associated with decreased blood transfusion or increased post-infusion fibrinogen level. Given that both fibrinogen upon admission and target fibrinogen levels were associated with decreased blood transfusion, earlier administration and higher doses of FBNc could be needed.
Highlights
This retrospective, single centre study was conducted to investigate the efficacy of fibrinogen concentrate (FBNc) in decreasing blood requirements and reaching optimal fibrinogen level, in non-trauma, massively transfused, bleeding patients with coagulopathy
Replacement of acquired fibrinogen deficiency with fibrinogen concentrate (FBNc) in patients with massive haemorrhage seems to be more efficacious than plasma in decreasing bleeding and transfusion rate [3]
Afterwards, for the second primary endpoint, we investigated those factors associated with reaching a target fibrinogen level of at least 2.0 g/L within a time period of 24 hours, regardless of whether they received or not FBNc. (Figure 2, bullet 3)
Summary
This retrospective, single centre study was conducted to investigate the efficacy of fibrinogen concentrate (FBNc) in decreasing blood requirements and reaching optimal fibrinogen level, in non-trauma, massively transfused, bleeding patients with coagulopathy. Replacement of acquired fibrinogen deficiency with fibrinogen concentrate (FBNc) in patients with massive haemorrhage seems to be more efficacious than plasma in decreasing bleeding and transfusion rate [3]. Supplementation with fibrinogen may be more effective when used as a part of an early goal-directed therapy in bleeding patients [5,6] In these cases, viscoelastic testguided, early FBNc administration, avoiding unacceptable standard laboratory test delays, has been shown to decrease blood transfusion requirements [5,6,7,8,9] and to be cost effective [8,9]
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