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Br J Anaesth. 2014 Dec;113(6):922-34. doi: 10.1093/bja/aeu158. Epub 2014 Jun 27.

Cryoprecipitate therapy.

Author information

1
Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
2
Departments of Pathology and Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
3
Departments of Anesthesiology and Surgery, Duke University School of Medicine, 2301 Erwin Road, 5691H HAFS, Box 3094, Durham, NC 27710, USA jerrold.levy@duke.edu.

Abstract

Cryoprecipitate, originally developed as a therapy for patients with antihaemophilic factor deficiency, or haemophilia A, has been in use for almost 50 yr. However, cryoprecipitate is no longer administered according to its original purpose, and is now most commonly used to replenish fibrinogen levels in patients with acquired coagulopathy, such as in clinical settings with haemorrhage including cardiac surgery, trauma, liver transplantation (LT), or obstetric haemorrhage. Cryoprecipitate is a pooled product that does not undergo pathogen inactivation, and its administration has been associated with a number of adverse events, particularly transmission of blood-borne pathogens and transfusion-related acute lung injury. As a result of these safety concerns, along with emerging availability of alternative fibrinogen preparations, cryoprecipitate has been withdrawn from use in a number of European countries. Compared with the plasma from which it is prepared, cryoprecipitate contains a high concentration of coagulation factor VIII, coagulation factor XIII, and fibrinogen. Cryoprecipitate is usually licensed by regulatory authorities for the treatment of hypofibrinogenaemia, and recommended for supplementation when plasma fibrinogen levels decrease below 1 g litre(-1); however, this threshold is empiric and is not based on solid clinical evidence. Consequently, there is uncertainty over the appropriate dosing and optimal administration of cryoprecipitate, with some guidelines from professional societies to guide clinical practice. Randomized, controlled trials are needed to determine the clinical efficacy of cryoprecipitate, compared with the efficacy of alternative preparations. These trials will allow the development of evidence-based guidelines in order to inform physicians and guide clinical practice.

KEYWORDS:

blood; blood coagulation factors; coagulation protein disorders; cryoprecipitate coagulum; fibrinogen; transfusion

PMID:
24972790
PMCID:
PMC4627369
DOI:
10.1093/bja/aeu158
[Indexed for MEDLINE]
Free PMC Article

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