Department of anaesthesia and intensive care, hôpital Cochin, CHU, Paris Descartes university, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Department of anaesthesia and intensive care, Erasme hospital, route de Lennik, 808, 1070, Brussels, Belgium.
Anaesth Crit Care Pain Med. 2018 Aug;37(4):355-365. doi: 10.1016/j.accpm.2018.04.002. Epub 2018 Apr 13.
The consumption of fibrinogen concentrates has been increasing steadily for several years in surgery, trauma and obstetrics. However, data from the literature are conflicting. The French Working Group on Perioperative Haemostasis (GIHP) proposes a position paper based on a narrative review of the literature, and addresses the following questions: What is the exact role of fibrinogen in haemostasis? Which rational support for the use of perioperative fibrinogen? Which thrombotic risk? What are the most recent professional recommendations on the use of fibrinogen concentrates? Then, evidence-based recommendations are proposed: 1) it is suggested not to administer prophylactic FC to prevent haemorrhage; 2) it is suggested not to use FC alone. Haemostatic treatment must be comprehensive, include other haemostatic treatments and must be limited in cases of severe active haemorrhage; 3) the GIHP suggests urgent measurement of fibrinogen plasma concentration in a biology laboratory or functional fibrinogen by viscoelastic methods. The choice between the two methods must be guided by the time to receive the results from a certified organisation with, in particular, authorisation to perform delocalised biologic examinations; 4) it is suggested not to administer FC when the fibrinogen concentration is superior to 1.5g/L or when there is a functional fibrinogen deficit (with the possible exception in obstetrics where the threshold could be 2.0g/L); 5) if FC are administered, an initial dose of 25-50mg/kg is proposed.
纤维蛋白原浓缩物在外科、创伤和产科领域的应用近年来稳步增长。然而，文献中的数据存在矛盾。法国围手术期止血工作组（GIHP）基于文献的叙述性综述提出了一份立场文件，并回答了以下问题：纤维蛋白原在止血中的确切作用是什么？围手术期使用纤维蛋白原的合理依据是什么？血栓形成风险有哪些？关于纤维蛋白原浓缩物使用的最新专业建议是什么？然后，提出了基于证据的建议：1）建议不要预防性使用 FC 来预防出血；2）建议不要单独使用 FC。止血治疗必须全面，包括其他止血治疗，并且必须在严重活动性出血的情况下加以限制；3）GIHP 建议在生物学实验室或通过粘弹性方法紧急测量纤维蛋白原血浆浓度。两种方法的选择必须根据从具有认证组织获得结果的时间来指导，特别是具有进行非本地化生物学检查的授权；4）建议当纤维蛋白原浓度高于 1.5g/L 或存在功能性纤维蛋白原缺乏时（在产科中可能除外，阈值可能为 2.0g/L）不要使用 FC；5）如果给予 FC，建议初始剂量为 25-50mg/kg。
