Fibrinogen IV Infusion Administration Protocol

Dosing Guidelines

For significant bleeding with plasma fibrinogen level <1 g/L, an initial dose of 3-4 g or 50 mg/kg is recommended, with a maximum rate of 20 mL per minute for acquired fibrinogen deficiency and 5 mL per minute for congenital fibrinogen deficiency, as suggested by the Critical Care society 1, 2, 3
For surgical prophylaxis, a dose of 25-50 mg/kg is recommended, according to the Journal of Thrombosis and Haemostasis society 4
Repeat doses should be guided by laboratory assessment of fibrinogen levels, with a target fibrinogen level of above 1.5-2.0 g/L for effective hemostasis, as recommended by the Journal of Thrombosis and Haemostasis society 4

Monitoring of fibrinogen levels before and after administration is recommended to guide dosing, with laboratory assessment of fibrinogen concentration or viscoelastic monitoring of functional fibrinogen, as suggested by the Journal of Thrombosis and Haemostasis society 4
Additional fibrinogen should not be administered if plasma concentration is over 1.5 g/L or if there is no evidence of functional fibrinogen deficiency on viscoelastic point-of-care analysis, according to the Journal of Thrombosis and Haemostasis society 4

For management of symptomatic intracranial bleeding after alteplase administration, a dose of 10 units of cryoprecipitate infused over 10-30 minutes is recommended, with an additional dose given if fibrinogen level is <200 mg/dL, as suggested by the Stroke society 5, 6, 7
The Critical Care society recommends that no blood should enter the syringe during administration due to risk of fibrin clot formation, and that allergic reactions and anaphylaxis are potential concerns as with any blood product 1, 2