Fibrinogen concentrate for treatment of bleeding and surgical prophylaxis in congenital fibrinogen deficiency patients

Toshko Lissitchkov, Bella Madan, Claudia Djambas Khayat, Nadezhda Zozulya, Cecil Ross, Mehran Karimi, Kaan Kavakli, Guillermo R. De Angulo, Abdulkareem Almomen, Kannan Subramanian, Fulton D'Souza, Auro Viswabandya, Hamid Hoorfar, Bruce A. Schwartz, Cristina Solomon, Sigurd Knaub, Flora Peyvandi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Congenital fibrinogen deficiency is an ultra-rare disorder in which patients can experience severe and/or frequent bleeding episodes (BEs). Here, we present the largest prospective study to date on the treatment of this disorder. Methods: Hemostatic efficacy of human fibrinogen concentrate (HFC; FIBRYGA®, Octapharma AG) for treatment of bleeding or surgical prophylaxis was assessed by investigators and adjudicated by an independent data monitoring and endpoint adjudication committee (IDMEAC) according to a four-point scale, using objective criteria. Thromboelastometry maximum clot firmness (MCF) was also determined. Results: Twenty-five afibrinogenemia patients were treated with HFC: 24 for on-demand treatment of 89 BEs, and nine as prophylaxis for 12 surgeries. For BEs, treatment success (rating of excellent or good) evaluated by investigators was 96.6% (90% confidence interval [CI], 0.92-0.99; two missing ratings, classified as failures) and by the IDMEAC was 98.9% (90% CI, 0.95-0.999). Mean ± standard deviation (SD) increase in MCF was 5.8 ± 2.5 mm one hour after the first HFC infusion (mean ± SD dose, 61.88 ± 11.73 mg/kg). For the 12 surgeries (median [range] HFC dose/surgery, 85.80 mg/kg [34.09-225.36]), intraoperative and postoperative treatment success were both rated 100% (90% CI, 0.82-1.00) by investigators and the IDMEAC. Three adverse events were possibly treatment related, including a moderate case of thrombosis. There were no deaths, no severe allergic or hypersensitivity reactions, and no clinical evidence of neutralizing antifibrinogen antibodies. Conclusions: Human fibrinogen concentrate was efficacious for on-demand treatment of bleeding and as surgical prophylaxis, with a favorable safety profile, in patients with congenital afibrinogenemia.

Original languageEnglish
Pages (from-to)815-824
Number of pages10
JournalJournal of Thrombosis and Haemostasis
Volume18
Issue number4
DOIs
Publication statusPublished - Apr 1 2020

Keywords

  • afibrinogenemia
  • fibrinogen
  • hemostasis
  • surgical prophylaxis
  • thrombelastography

ASJC Scopus subject areas

  • Hematology

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