Now in the bleeding session and Peter Collins is talking on role of fibrinogen in bleeding #BSH2017
Making distinction between lab test results and ability to stop bleeding in vivo #BSH2017
Does higher fg = better ability to control haemorrhage? Or does it just make clot stronger? Once above 2g/L does the value matter? #BSH2017
Cryoprecipitate standard fg product in UK; fg conc not routinely available #BSH2017
FFP has 2.5g/L fg; less than physiological levels in many bleeding patients, esp in obstetrics #BSH2017
We have insufficient knowledge of haemostatic mechanisms in post partum haemorrhage- even less well understood than in trauma... #BSH2017
Very few women w PPH have incr INR until blood loss >5000ml i.e. women not usually deficient in most clotting factors when bleeding #BSH2017
but fg falls early and also predicts for bleeding (Collins et al. Blood 124 2014) #BSH2017
This study showed no effect of pre emptive fg replacement because fg concs were not reduced academic.oup.com/bja/article/11… #BSH2017
OBS2 study used viscoelastic testing to guide fg replacement; fg conc if FIBTEM<16. Fg replacement did not improve outcomes #BSH2017
but findings suggest when fg <2g/L, fg replacement may improve outcomes #BSH2017
Trauma induced coagulopathy different to obs& relates to activation of Protein C, endothelial dysfunction &hypo/dysfibrinogenaemia #BSH2017
Role of TXA in CRASH2 widely stated but remember worse outcomes when given after 3h #BSH2017
Worse outcomes seen with low fg levels in trauma - similar picture to obstetrics. Association but ??causation #BSH2017
Will Cryostat2 provide answers? #BSH2017 nhsbt.nhs.uk/clinicaltrials…
As always, need to pick patients carefully. MHP readily activated in our institution, small proportion go on to pack 2 #BSH2017
Cardiac surgery: 2 studies of fg use in bleeding pts showed no diff in outcomes ncbi.nlm.nih.gov/pubmed/27317703 jamanetwork.com/journals/jama/… #BSH2017
Treat different bleeding types differently. What is optimum fg level? (prob no benefit above 2 says Prof Collins) #BSH2017
Prof Collins makes point that fg conc could easily be kept in ED (or in ambulances). But does it save lives?? #BSH2017
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