Fibrinogen supplementation ex vivo increasesclot firmness comparable to platelet transfusion in thrombocytopenia†

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Background: Fibrinogen concentrate can improve clot firmness and offers a better safety profile than platelet concentrates. Reduction or avoidance of blood transfusions represents a strategy to reduce associated risks. We investigated whether supplementation of fibrinogen concentrate ex vivo can compensate for clot strength as compared with platelet transfusion in vivo.Methods: One hundred patients in need of platelet transfusion (PT) were enrolled. Blood samples were collected immediately before PT and at 1 h and 24 h after PT. Fibrinogen concentrate was added to these citrated whole blood samples at concentrations of 50, 100, 200 and 400 mg kg−1 and the maximum clot firmness (MCF) was analysed using ROTEM thromboelastometry.Results: Fibrinogen supplementation increased MCF significantly and dose-dependently before and after PT. The effect of fibrinogen concentrate (equivalent to doses of 100 and 200 mg kg−1) ex vivo was comparable to that of PT in vivo, whereas 400 mg kg−1 fibrinogen significantly improved MCF compared with PT (P < 0.001).Conclusions: Fibrinogen concentrate can match the effect of PT on MCF in thrombocytopenia. This potential alternative haemostatic intervention should be evaluated in clinical trials.

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