Administration of fibrinogen concentrates to patients with severe bleeding. How much is enough?

Abstract

Fibrinogen concentrate (FC) should be administered to patients with severe bleeding, preferably guided by viscoelastic hemostatic assays (VHAs) or plasma fibrinogen level (Clauss method) if VHAs are not available. However, it may be blindly prescribed (without coagulation testing) in patients with life-threatening hemorrhage. Preemptive or prophylactic FC administration in patients without moderate or severe bleeding is not recommended. There is no consensus regarding the minimum FC dose that should be prescribed, although it seems reasonable to administer 3-4 g as soon as possible. FC appears to have a good safety profile and is well tolerated; available evidence does not suggest an increased rate of thromboembolic events associated with its administration.