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Purpose of Review <p>This review aims to discuss fibrinogen-rich products—cryoprecipitate and fibrinogen concentrate—for fibrinogen replacement during PPH, as well as the benefits, key studies of use during PPH, and the role of viscoelastic testing.</p> Recent Findings <p>In vitro studies demonstrate the superiority of fibrinogen concentrate to correct acquired hypofibrinogenemia. Retrospective and prospective studies evaluating targeted fibrinogen replacement using viscoelastic testing have consistently demonstrated a reduction in total transfused units, fewer plasma units administered, and lower rates of transfusion-associated lung injury and transfusion-associated circulatory overload. Universal prophylactic fibrinogen administration to patients at the onset of PPH does not yield improved clinical outcomes. In studies demonstrating this finding, the median serum fibrinogen concentration at the time of fibrinogen concentrate administration was &gt; 400&#xa0;mg/dL.</p> Summary <p>Fibrinogen replacement shows promise as a treatment for obstetric coagulopathy. However, prophylactic fibrinogen replacement does not decrease blood loss or improve clinical outcomes.</p>

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Fibrinogen Replacement during Postpartum Hemorrhage: Comparing Plasma, Cryoprecipitate, and Fibrinogen Concentrate

  • 期刊论文

  • 发表日期：

    2025年3月27日

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  • John J. Kowalczyk,
  • Michaela K. Farber,
  • Amir L. Butt

摘要

Purpose of Review

This review aims to discuss fibrinogen-rich products—cryoprecipitate and fibrinogen concentrate—for fibrinogen replacement during PPH, as well as the benefits, key studies of use during PPH, and the role of viscoelastic testing.

Recent Findings

In vitro studies demonstrate the superiority of fibrinogen concentrate to correct acquired hypofibrinogenemia. Retrospective and prospective studies evaluating targeted fibrinogen replacement using viscoelastic testing have consistently demonstrated a reduction in total transfused units, fewer plasma units administered, and lower rates of transfusion-associated lung injury and transfusion-associated circulatory overload. Universal prophylactic fibrinogen administration to patients at the onset of PPH does not yield improved clinical outcomes. In studies demonstrating this finding, the median serum fibrinogen concentration at the time of fibrinogen concentrate administration was > 400 mg/dL.

Summary

Fibrinogen replacement shows promise as a treatment for obstetric coagulopathy. However, prophylactic fibrinogen replacement does not decrease blood loss or improve clinical outcomes.