Practical considerations for fibrinogen replenishment: a comparison

Unlike FFP and cryoprecipitate, fibrinogen concentrate is a single-factor agent. Despite this, fibrinogen concentrate has been shown to be as effective as FFP and cryoprecipitate, indicating that additional coagulation factors present in FFP and cryoprecipitate are unlikely to impact on treatment outcome for most cases. In terms of replenishment, there appears to be no additional clinical benefit of using fibrinogen concentrate over FFP or cryoprecipitate. The major differentiating factors to consider in the clinic is therefore speed of preparation, storage and safety (Table 5).

Table 5: Comparison of fresh frozen plasma (FFP), cryoprecipitate and fibrinogen concentrate (FCH) (adapted from Wong & Curry, 2018).

Comparison of fresh frozen plasma


FFP and cryoprecipitate are more widely available and cheaper to source than fibrinogen concentrate; however, indirect costs for preparation, transportation, storage and associated wastage are often overlooked and need to be considered in evaluating real-term cost-effectiveness (Sørensen & Bevan, 2010; Nascimento et al., 2014; Wong & Curry, 2018). A recent study calculated that after considering 28% wastage for cryoprecipitate, a further 44% reduction in cost of fibrinogen concentrate or a significant reduction in time spent at ICU would be needed to match the cost of cryoprecipitate (Okerberg et al., 2016).

Significant benefits in safety and effectiveness are required to make fibrinogen concentrate economically viable (Wong & Curry, 2018). Product preparation and time to administer impact on the safety of use. The amount of fibrinogen in fibrinogen concentrate is standardised whereas the amount of fibrinogen in cryoprecipitate varies on average between 15–17 g/L but has also been shown to vary drastically from 3–30 g/L (Nascimento et al., 2014; Wong & Curry, 2018). Unlike with FFP and cryoprecipitate, the preparation of fibrinogen concentrate involves viral inactivation and removal of antibodies and antigens that can trigger an allergic response. The former means that fibrinogen concentrate carries a significantly reduced risk of viral infection and the latter eliminates the need for blood group matching. In terms of preparation, FFP and cryoprecipitate require blood group matching and approximately 17–20 minutes for thawing at 30–37°C. Fibrinogen concentrate takes approximately 10 minutes to reconstitute and is administered faster and at lower volumes (100 mL) compared to FFP and cryoprecipitate, thereby reducing the risk of transfusion volume-related complications. Reported adverse events are similar (Wong and Curry, 2018). There are clear advantages for using fibrinogen concentrate over standard cryoprecipitate therapy however further studies are needed to ascertain true costs, safety and effectiveness of fibrinogen concentrate compared to cryoprecipitate.

To learn more about the use of fresh frozen plasma, cryoprecipitate and fibrinogen concentrate, visit here.  

 

Take a look at the references used in the treatment section here.
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