Assessment of Fibrinogen Replacement Therapy by the Combined Simulation of the Fibrinogen Concentration and Fibrin Polymerization

Fibrinogen replacement therapy is effective for attaining perioperative hemostasis in critical bleeding due to acquired hypofibrinogenemia. By simulating the fibrinogen level and fibrin polymerization, we compared the effect of fibrinogen replacement therapy using cryoprecipitate or fibrinogen concentrate versus the effect of fresh frozen plasma.We simulated the plasma concentration of fibrinogen during fibrinogen replacement therapy in a model of cardiopulmonary bypass (CPB) and intensive care unit (ICU). We estimated fibrin polymerization (FIBTEM A10, thromboelastometry) by the simulated fibrinogen level, and compared this value with the fibrinogen level and FIBTEM in clinical patients.In the simulation model of CPB and ICU, cryoprecipitate and fibrinogen concentrate both effectively restored the fibrinogen level and FIBTEM, compared to fresh frozen plasma. In clinical patients, the simulated values of the fibrinogen level and FIBTEM after administering the fibrinogen concentrate were similar to the measured values.In the simulation model, which combines the fibrinogen level and fibrin polymerization, cryoprecipitate and fibrinogen concentrate effectively normalize the fibrinogen level and fibrin polymerization, compared to fresh frozen plasma. The fibrinogen concentrate also demonstrated efficacy in treating hypofibrinogenemia in clinical patients. The combined simulation model is useful in assessing the efficacy of fibrinogen replacement therapy by cryoprecipitate or by fibrinogen concentrate.