The efficacy of fibrinogen concentrate compared with cryoprecipitate in major obstetric haemorrhage - an observational study

SUMMARY 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.