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October 21, 2019

Should Fibrinogen Concentrate Replace Cryoprecipitate in Cardiac Surgery?

Author Affiliations
  • 1Department of Anesthesiology, University of Wisconsin-Madison
  • 2Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison
  • 3Department of Laboratory Medicine, University of Washington, Seattle
  • 4Department of Medicine, University of Wisconsin-Madison
JAMA. 2019;322(20):1958-1960. doi:10.1001/jama.2019.17313

Excessive bleeding presents a critical medical challenge. Many of the problems encountered at the bedside, such as inadequate measures of coagulation, challenges in delivering blood components, uncertain role of prothrombotic drugs or antifibrinolytics, dilutional coagulopathy, varied clinical settings, and patient comorbidities, have occupied a great deal of recent research effort and still have only imperfect solutions. Fibrinogen is an essential component of hemostasis: it is cleaved by thrombin into fibrin, which polymerizes into factor XIII–crosslinked fibers that have important functions in adhesion, platelet aggregation, and inflammation.1 A low fibrinogen level is an ominous finding in patients with bleeding, but it has been difficult to prove the utility of direct fibrinogen replacement.2 More than 20 small trials have suggested that using fibrinogen concentrate reduces bleeding and transfusions in various clinical situations, but any general conclusions are limited by the study sizes, quality, and heterogeneity in methods.3,4