Inter-institutional perspectives on usage of fibrinogen replacement therapies in North America.

BACKGROUND AND OBJECTIVES: Cryoprecipitated antihemophilic factor (cryoprecipitate), fibrinogen concentrate (FC), and pathogen-reduced cryoprecipitated fibrinogen complex (PR cryoprecipitate) are sources of fibrinogen replacement, and each has advantages and disadvantages in terms of cost, efficacy, safety, and logistics of administration. This study examines the respective utilization frequencies of these different products at institutions in North America and the factors influencing the decision on which one(s) to adopt. MATERIALS AND METHODS: A survey was distributed via email to contacts for Advancement of Blood and Biotherapies (AABB)-accredited blood banks/transfusion services. Survey questions covered topics including the availability and usage of FC, cryoprecipitate, and PR cryoprecipitate, as well as the perceived advantages of each product. RESULTS: A total of 53 responses were received from surveyed institutions (estimated 25% response rate). Over half (31/53, 58.5%) of respondents exclusively used cryoprecipitate, 30.2% (16/53) used two sources of fibrinogen replacement, and 7.5% (4/53) used all three (cryoprecipitate, FC, and PR cryoprecipitate). More than half of the institutions restricted FC to specific indications, primarily for cost containment. The most commonly cited advantages of FC over cryoprecipitate were storage convenience and rapid reconstitution. CONCLUSION: Surveyed institutions in the United States and Canada primarily use cryoprecipitate for fibrinogen replacement, with variable usage of FC and limited usage of PR cryoprecipitate. The perception of FC being more expensive than cryoprecipitate predominated. Further studies comparing available fibrinogen replacement options would be valuable, particularly with consideration of product acquisition cost, wastage, impacts on utilization of other blood products, and patient outcomes.