Fibrinogen supplementation ex vivo increasesclot firmness comparable to platelet transfusion in thrombocytopenia.

Schenk, B; Lindner, A K; Treichl, B; Bachler, M; Hermann, M; Larsen, O H; Fenger-Eriksen, C; Wally, D et al. · Br J Anaesth · 2016

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Abstract

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<sup>-1</sup> and the maximum clot firmness (MCF) was analysed using ROTEM thromboelastometry. 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<sup>-1</sup>) ex vivo was comparable to that of PT in vivo, whereas 400 mg kg<sup>-1</sup> fibrinogen significantly improved MCF compared with PT (P < 0.001). Fibrinogen concentrate can match the effect of PT on MCF in thrombocytopenia. This potential alternative haemostatic intervention should be evaluated in clinical trials.

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