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

Authors: Kowalczyk, JJ; Farber, MK; Butt, AL

Affiliations: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, USA. Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

Publication: Current Anesthesiology Reports; 2025; 15

ABSTRACT:  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.