PB0489 - Audit of the use of Fibclot (Fibrinogen concentrate) in patients without congenital afibrinogenaemia

Background: Fibclot is licensed for use in patients with congenital hypo or afibrinogenaemia with a bleeding tendency. The recommended initial dose in an emergency situation is 0.05g per kg of body weight aiming for a level of 1g/l in non surgical bleeding.

Aims: To assess the indications and increments achieved in patients who had received Fiblclot.

Methods: This was an audit that collected information for the period March to December 2021; the point at which Fibclot had been introduced to the trust, using commissioning data and patient case notes.

Results: Information from 30 patients was analysed; 63% were women (n=19) with a mean age of 41.47 years (range 0-87). The clinical indications were: disseminated intravascular coagulopathy (DIC)-10%, post-partum haemorrhage (PPH)-46.7%, acquired bleeding disorders 10%, liver disease 16.7%, cardiac surgery 10% and neonatal coagulopathy 6.7%.
Mean plasma fibrinogen levels in all clinical indications pre and post Fibclot was 2.67 (range: 0.3-4.5, median: 1.6) and 2.9 (range: 0.7-5.1, median: 2.5) (n=18). Excluding patients with PPH, mean plasma fibrinogen pre and post Fibclot was 1.48 (range: 0.3-3.9) and 2.12 (range: 0.7-5.1). In patients with DIC (n=2), mean plasma fibrinogen levels pre and post Fibclot was 0.85 and 1.4.
The mean and median Fibclot dosage was 0.04g/kg (range of 0.02g/kg-0.08g/kg).
One patient with DIC experienced expressive dysphasia during the infusion of Fibclot. The infusion was stopped and a subsequent CT head was normal. Her symptoms resolved within 24hours and she received further doses of Fibclot without neurological symptoms. There were no other documented side effects. Cessation and prevention of haemorrhage was achieved in 26/30 patients who survived until hospital discharge.

Conclusion(s): Fibclot has been used in patients with a range of clinical indications in order to raise fibrinogen levels to a sufficient degree to achieve haemastasis.