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Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding.

Publication ,  Other
Levy, JH; Szlam, F; Tanaka, KA; Sniecienski, RM
Published in: Anesth Analg
February 2012

Fibrinogen plays several key roles in the maintenance of hemostasis. Its cleavage by thrombin and subsequent polymerization to form fibrin strands provides the structural network required for effective clot formation. During cases of acute blood loss, attempts to maintain circulating volume and tissue perfusion often involve the infusion of crystalloids, colloids, and red blood cells. Intravascular volume resuscitation, although vital, frequently results in dilution of the remaining clotting factors and onset of dilutional coagulopathy. In such cases, fibrinogen is the first coagulation factor to decrease to critically low levels. There currently is a lack of awareness among physicians regarding the significance of fibrinogen during acute bleeding and, at many centers, fibrinogen is not monitored routinely during treatment. We reviewed current studies that demonstrate the importance of considering fibrinogen replacement during the treatment of acquired bleeding across clinical settings. If depleted, the supplementation of fibrinogen is key for the rescue and maintenance of hemostatic function; however, the threshold at which such intervention should be triggered is currently poorly defined. Although traditionally performed via administration of fresh frozen plasma or cryoprecipitate, the use of lyophilized fibrinogen (concentrate) is becoming more prevalent in some countries. Recent reports relating to the efficacy of fibrinogen concentrate suggest that it is a viable alternative to traditional hemostatic approaches, which should be considered. The prospective study of fibrinogen supplementation in acquired bleeding is needed to accurately assess the range of clinical settings in which this management strategy is appropriate, the most effective method of supplementation and a comprehensive safety profile of fibrinogen concentrate used for such an approach.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 2012

Volume

114

Issue

2

Start / End Page

261 / 274

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Postoperative Hemorrhage
  • Humans
  • Hemostatics
  • Hemostatic Techniques
  • Hemostasis
  • Hemorrhage
  • Fibrinogen
  • Factor VIII
  • Blood Loss, Surgical
 

Citation

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Chicago
ICMJE
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Levy, J. H., Szlam, F., Tanaka, K. A., & Sniecienski, R. M. (2012). Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding. Anesth Analg. United States. https://doi.org/10.1213/ANE.0b013e31822e1853
Levy, Jerrold H., Fania Szlam, Kenichi A. Tanaka, and Roman M. Sniecienski. “Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding.Anesth Analg, February 2012. https://doi.org/10.1213/ANE.0b013e31822e1853.
Levy JH, Szlam F, Tanaka KA, Sniecienski RM. Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding. Vol. 114, Anesth Analg. 2012. p. 261–74.
Levy, Jerrold H., et al. “Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding.Anesth Analg, vol. 114, no. 2, Feb. 2012, pp. 261–74. Pubmed, doi:10.1213/ANE.0b013e31822e1853.
Levy JH, Szlam F, Tanaka KA, Sniecienski RM. Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding. Anesth Analg. 2012. p. 261–274.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 2012

Volume

114

Issue

2

Start / End Page

261 / 274

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Postoperative Hemorrhage
  • Humans
  • Hemostatics
  • Hemostatic Techniques
  • Hemostasis
  • Hemorrhage
  • Fibrinogen
  • Factor VIII
  • Blood Loss, Surgical