Fibrinogen concentrate cost-effective than cryoprecipitate for managing bleeding in cardiac surgery patients: JAMA

One of the serious complications of cardiac surgery is excessive bleeding requiring fibrinogen replacement. The relative cost-effectiveness of the two available therapies—FC and cryoprecipitate remain unspecified.

The main question is whether FC is more cost-effective than cryoprecipitate for adult patients who underwent cardiac surgery and experienced active bleeding causing acquired hypofibrinogenemia.

To determine the answer to this question, Lusine Abrahamyan, MD, MPH, PhD and colleagues did a study comparing FC vs cryoprecipitate in adult patients. The researchers used the intervention Fibrinogen concentrate of 4 g per dose or cryoprecipitate of 10 units per dose which is randomized (1:1) up to 24 hours post-cardiopulmonary bypass.

The study points are:

• The participants were 495 adults from the FIBERS trial. These underwent cardiac surgery and acquired hypofibrinogenemia due to active bleeding requiring fibrinogen replacement.
• The primary outcomes were the number of Allogeneic Blood Products (ABPs) administered within 24 h and seven days of cardiopulmonary bypass.
• The mean age of participants was 59.2 years and was 69.3 % male.
• There were similarities in ABP transfusions and adverse events in both treatment groups.
• The median total 7-day allogenic blood product (ABP) transfusion cost was CAD $2280 in the fibrinogen concentrate group and CAD $2770 in the cryoprecipitate group.

• The median total 28-day cost was CAD $38 180 in the fibrinogen concentrate group and CAD $38 790 in the cryoprecipitate group.
• Fibrinogen concentrate vs cryoprecipitate incremental net benefit was positive after excluding critically ill patients before surgery, constituting 11 %
• Net benefit was highly uncertain for nonelective and patients with a critical illness.

To conclude, Fibrinogen concentrate is more cost-effective than cryoprecipitate. The researchers said that The incremental net benefit of fibrinogen concentrate vs cryoprecipitate was positive, with an 86% and 97% probability of being cost-effective at $0 and CAD $2000, respectively.

They mentioned that the generalizability of these findings outside the Canadian health system needs to be verified.

Further reading:

Abrahamyan L, Tomlinson G, Callum J, et al. Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients. JAMA Surg. Published online January 04, 2023. doi:10.1001/jamasurg.2022.6818