Department of Anaesthesiology, Hospital de la Santa Creu i Sant Pau, Departamento de Cirugía, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
Hematopathology, Pathology Department, CDB, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Drugs Today (Barc). 2021 Mar;57(3):219-239. doi: 10.1358/dot.2021.57.3.3250287.
Acquired hypofibrinogenemia is a frequent cause of maintained bleeding in perioperative high-risk settings. Loss, consumption and dilution under resuscitation fluid therapy are the principal causes for fibrinogen depletion. Severe hypofibrinogenemia is frequently associated with an early bleeding complication that cannot be reliably avoided with high-ratio plasma transfusion strategies. Real-time monitoring with viscoelastic hemostatic assays is a useful tool for timely diagnosis and treatment of detected coagulopathies. Replenishment of fibrinogen in uncontrolled bleeding events is currently recommended by most published guidelines, suggesting treatment thresholds to maintain a minimum of 1.5 g/L plasma fibrinogen concentration for nonobstetrical hemorrhage. Fibrinogen concentrates, originally licensed for treatment of bleeding episodes in patients with congenital hypo-, dys- or afibrinogenemia disorders, are used in many clinical situations as supplementary therapy for the treatment of acquired hypofibrinogenemia. This review seeks to provide an overview of the most relevant topics associated to fibrinogen replacement therapy for critical perioperative hemorrhage highlighting currently available evidence on the risk/benefit profile of purified fibrinogen concentrates for this extended clinical indication.
获得性低纤维蛋白原血症是围手术期高危情况下持续出血的常见原因。在复苏液治疗中，纤维蛋白原的丢失、消耗和稀释是纤维蛋白原消耗的主要原因。严重的低纤维蛋白原血症常伴有早期出血并发症，即使采用高比例血浆输注策略也不能可靠地避免。使用黏弹性止血检测进行实时监测是及时诊断和治疗发现的凝血功能障碍的有用工具。大多数已发表的指南建议在不受控制的出血事件中补充纤维蛋白原，建议治疗阈值为维持非产科出血时血浆纤维蛋白原浓度至少 1.5g/L。纤维蛋白原浓缩物最初被批准用于治疗先天性低纤维蛋白原血症、异常纤维蛋白原血症或无纤维蛋白原血症患者的出血发作，在许多临床情况下，作为补充治疗用于治疗获得性低纤维蛋白原血症。本综述旨在提供围手术期大出血相关纤维蛋白原替代治疗的概述，重点介绍目前关于纯化纤维蛋白原浓缩物在这一扩展临床适应证的风险/获益情况的现有证据。
