{Reference Type}: Journal Article
{Title}: Management of congenital quantitative fibrinogen disorders: a Delphi consensus.
{Author}: Casini A;de Moerloose P; ;
{Journal}: Haemophilia
{Volume}: 22
{Issue}: 6
{Year}: Nov 2016
{Factor}: 4.263
{DOI}: 10.1111/hae.13061
{Abstract}: <B>BACKGROUND: </B>No evidence-based guidelines for the management of patients suffering from afibrinogenaemia and hypofibrinogenaemia are available.<BR><B>OBJECTIVE: </B>The aim of this study was to harmonize patient's care among invited haemophilia experts from Belgium, France and Switzerland. A Delphi-like methodology was used to reach a consensus on: prophylaxis, bleeding, surgery, pregnancy and thrombosis management.<BR><B>RESULTS: </B>The main final statements are as follows: (i) a secondary fibrinogen prophylaxis should be started after a first life-threatening bleeding in patients with afibrinogenaemia; (ii) during prophylaxis the target trough fibrinogen level should be 0.5 g L-1 ; (iii) if an adaptation of dosage is required, the frequency of infusions rather than the fibrinogen amount should be modified; (iv) afibrinogenaemic patients undergoing a surgery at high bleeding risk should receive fibrinogen concentrates regardless of the personal or family history of bleeding; (v) moderate hypofibrinogenaemic patients (i.e. ≥0.5 g L-1 ) without previous bleeding (despite haemostatic challenges) undergoing a surgery at low bleeding risk may not receive fibrinogen concentrates as prophylaxis; (vi) monitoring the trough fibrinogen levels should be performed at least once a month throughout the pregnancy and a foetal growth and placenta development close monitoring by ultrasound is recommended; (vii) fibrinogen replacement should be started concomitantly to the introduction of anticoagulation in afibrinogenaemic patients suffering from a venous thromboembolic event; and (viii) low-molecular-weight heparin is the anticoagulant of choice in case of venous thromboembolism.<BR><B>CONCLUSIONS: </B>The results of this initiative should help clinicians in the difficult management of patients with congenital fibrinogen disorders.