Prof. Dietmar FRIES
Coordinator of Science and Research
Department of Surgical and General Care Medicine
Medizinische Universität Innsbruck, Innsbruck, Austria
Dietmar Fries, MD is an Associate Professor at Innsbruck Medical University in the Department of Anaesthesiology and Critical Care Medicine. He also has an MSc for the quality and process management of healthcare which he obtained in 2017. Dr Fries is the Intensive Care Medicine coordinator in the province of Tirol, the department head of the Trauma Intensive Care Unit within the Department of General and Surgical Critical Care Unit, and the coordinator of science and research at the Department of General and Surgical Intensive Care Medicine. He was also formerly the deputy director of the Department of General and Surgical Critical Care Unit between 2017 and 2020. His research interests are the reversal of trauma-induced coagulopathy and the management of severe perioperative bleeding.
Fibrinogen (Factor I) is the first depleted coagulation factor during massive bleeding. Together with Factor XIII and platelets, fibrinogen plays its key role in clot formation and stabilization. Randomized studies and guidelines have pointed out fibrinogen level being critical in different clinical scenarios, including cardiac surgery, post-partum haemorrhage, liver transplant, neurosurgery and trauma.
Historically, fibrinogen is replenished via fresh frozen plasma or cryoprecipitate. However, allogenic plasma transfusion is on one side insufficient to replace fibrinogen, and on the other side associated with severe complications like acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS) and pneumonia. With recent development of fibrinogen concentrate, individualized goal-directed transfusion management is made feasible as a point-of-care management modality.
This lecture will discuss on how fibrinogen concentrate plays its role in the management of acquired hypofibrinogenemia and leads to improved clinical outcomes, e.g. reduced massive blood transfusion, mortality. More specifically, surgery-based fibrinogen target and key scientific data will be discussed in detail to enlighten on its clinical pearl.