The efficacy of fibrinogen concentrate compared with cryoprecipitate in major obstetric haemorrhage–an observational study
Abstract
BACKGROUND: Fibrinogen replacement is critical in major obstetric haemorrhage (MOH). Purified, pasteurised fibrinogen concentrate appears to have benefit over cryoprecipitate in ease of administration and safety but is unlicensed in pregnancy. In July 2009, the Irish Blood Transfusion Service replaced cryoprecipitate with fibrinogen. OBJECTIVES: To examine the impact of this externally imposed change on blood product use and clinical outcomes in MOH. METHODS: Women with MOH requiring fibrinogen between 1 January 2009 and 30 June 2011 were identified from an MOH database. Aetiology of MOH, medical treatments, blood product use and clinical outcomes were compared between the cryoprecipitate and fibrinogen groups. RESULTS: Of 21 614 deliveries, 77 cases of MOH were identified. Of the 77 cases, 34 (44%) received cryoprecipitate (n = 14) or fibrinogen concentrate (n = 20). The mean (± SEM) dose utilised was 2.21 ± 0.35 pools of cryoprecipitate and 4 ± 0.8 g of fibrinogen. There was a stronger correlation between the increase in fibrinogen level and dose of fibrinogen (Pearson co-efficient 0.5; P = 0.03) than dose of cryoprecipitate (Pearson co-efficient 0.32; P = 0.3). Mean (± SEM) estimated blood loss (EBL), red cell concentrate (RCC) and Octaplas transfused were greater (but not significantly) in the cryoprecipitate group compared with the fibrinogen group; EBL = 5.2 ± 1.1 vs 3.3 ± 0.5 L (P = 0.1); RCC = 7.2 ± 1.2 vs 5.9 ± 1.0 U (P = 0.4); Octaplas = 4.1 ± 0.7 vs 3.2 ± 0.7 U (P = 0.36), respectively. Haemostasis was secured, and there were no adverse reactions or thrombotic complications. CONCLUSION: Purified virally inactivated fibrinogen concentrate is as efficacious as cryoprecipitate in correcting hypofibrinogenaemia in MOH.
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In active bleeding, fibrinogen concentrates used as an adjunctive treatment of obstetrical hemorrhage may reduce the need for massive transfusion.
“In cases of active bleeding, the use of fibrinogen concentrates as an adjunctive treatment of obstetrical hemorrhage may reduce the need for massive transfusion (104, 105).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [105]
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- Authors
- Ahmed, S., Harrity, C., Johnson, S., Varadkar, S., McMorrow, S., Fanning, R., Flynn, C. M., O' Riordan, J. M., & Byrne, B. M.
- Affiliations
- Coombe Women & Infants University Hospital (IE)
- Irish Blood Transfusion Service National Blood Centre Dublin Ireland
- Corresponding author
- Byrne, B. M.
- Venue
- Transfusion Medicine
- Publisher
- Wiley
- Published
- 2012-09-20
- Volume
- 22
- Issue
- 5
- Pages
- 344-349
- ISSN
- 0958-7578 (ISSN-L)
- 1365-3148
- OpenAlex
- W1853981075
- Cited by
- 118
- References
- 25
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 8 · 2023: 9 · 2022: 3 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 7 · 2017: 15 · 2016: 12 · 2015: 14 · 2014: 14 · 2013: 6 · 2012: 1
- FWCI
- 7.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transfusion Medicine (publishedVersion)
- PubMed (publishedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- major obstetric haemorrhage, fibrinogen concentrate, cryoprecipitate, fibrinogen replacement, blood product utilization, estimated blood loss, packed red blood cells, hemostasis, transfusion policy, pregnancy, hypofibrinogenemia, thrombocytopenia, coagulopathy, transfusion safety, thrombotic complications
- MeSH terms
- Adult, Coagulants, Factor VIII, Female, Fibrinogen, Hemorrhage, Humans, Ireland, Pregnancy, Prospective Studies, Blood Loss, Surgical, Delivery, Obstetric
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