Factor 1

[sleepmeister]

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Anyone have any experience giving factor 1 concentrate in US?

 

[coffeebythelake]

what's the benefit of giving this vs giving cryoppt?
this concentrate is probably much more expensive

 

[UrbanAchievers]

what's the benefit of giving this vs giving cryoppt?
this concentrate is probably much more expensive

Agreed. If I’m giving fibrinogen, I give cryo.

 

[Iso4ane]

Agreed. If I’m giving fibrinogen, I give cryo.

It’s kinda of a Hail Mary, and one can usually get factor I concentrate a tad faster than a unit of cryo.

 

[drmwvr]

Coags/ PLT/ Fibrinogen levels or Rotem to guide product admin?

 

[coffeebythelake]

It’s kinda of a Hail Mary, and one can usually get factor I concentrate a tad faster than a unit of cryo.

getting it faster isn't an argument in favor for this drug.
think about indication for use.
if someone is hemorrhaging and has coagulopathy, giving them factor 1 concentrate isn't going to fix the problem
you would only reasonably use it the concentrate in patients with congenital afibrinogenemia or hypofibrinogenemia
that's the indication on the manufacturer's website RiaSTAP Fibrinogen Concentrate (Human)
it is also 3-4 times more expensive per mg of fibrinogen than cryoppt
and it is derived from blood, not recombinant, so the risk of transmitting infection still exist

 

[drmwvr]

so the risk of transmitting infection still exist

so does the risk of blood continued bleeding and the subsequent addition of unit after unit of blood product. Bleeding carries risk too...

 

[coffeebythelake]

so does the risk of blood continued bleeding and the subsequent addition of unit after unit of blood product. Bleeding carries risk too...

i'm in favor of treating bleeding
TXA works and has been shown in hemorrhage to improve morbidity and mortality
obviously give blood products when necessary

all i'm saying is Factor I concentrate isn't going to solve problems in the usual hemorrhaging patient
and it isn't necessarily safer than cryoppt

 

[sleepmeister]

But isn't it a lyophylized powder, so no infectious risk? And giving it faster may be an issue in an emergency because cryo needs to be thawed. Plus, it's less volume. I heard a while back they were using it in Europe to Rx hemorrhagic coagulopathy, as in trauma, with favorable results, although the data was preliminary. They targeted levels as high as 1.5 g/dL. Now that PCCs are becoming more popular, maybe that will take it's place as factor replacement therapy in trauma. Just wondering if anybody had any experience with that practice here in US.

 

[drmwvr]

i'm in favor of treating bleeding
TXA works and has been shown in hemorrhage to improve morbidity and mortality
obviously give blood products when necessary

all i'm saying is Factor I concentrate isn't going to solve problems in the usual hemorrhaging patient
and it isn't necessarily safer than cryoppt

My bleeding patient are 80% post CPB and get everything before going to factor 7

i'm in favor of treating bleeding
TXA works and has been shown in hemorrhage to improve morbidity and mortality
obviously give blood products when necessary

all i'm saying is Factor I concentrate isn't going to solve problems in the usual hemorrhaging patient
and it isn't necessarily safer than cryoppt

Agreed...anyway, by the time you're thinking cryo in any form (I've given hundreds of units of cryo and never, not one syringe of F1) adding the exposure of one more component to the multiple you've already given is trivial.

At the end of the day refractory bleeding only ends in death or Novo 7

 

[coffeebythelake]

But isn't it a lyophylized powder, so no infectious risk? And giving it faster may be an issue in an emergency because cryo needs to be thawed. Plus, it's less volume. I heard a while back they were using it in Europe to Rx hemorrhagic coagulopathy, as in trauma, with favorable results, although the data was preliminary. They targeted levels as high as 1.5 g/dL. Now that PCCs are becoming more popular, maybe that will take it's place as factor replacement therapy in trauma. Just wondering if anybody had any experience with that practice here in US.

Cryo doesn't have much volume... u aren't going to get TACO from it. The website from the manufacturer specifically says derived from human blood products, and specifically mentions risk of blood borne infection.

 

[sleepmeister]

Cryo doesn't have much volume... u aren't going to get TACO from it. The website from the manufacturer specifically says derived from human blood products, and specifically mentions risk of blood borne infection.

I agree that there's not much volume in Cryo, and the manufacturer of RiaSTAP does say, "RiaSTAP is made from pooled human plasma. Products made from human plasma may contain infectious agents, eg, viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent." They have to. But if you look at, say, rxlist, you'll see it is pretty free from viral contamination and is thus considered "virally inactivated".

 

[sleepmeister]

The rationale for considering fibrinogen concentrate for trauma and obstetrical hemorrhage is fibrinogen is the first factor depleted in trauma, is a lyophilized power, and doesn't have the storage/access problems of FFP or cryo, just like PCCs. But like PCCs, they have the problems of producing hypercoaguability and insufficient proof for use in massive hemorrhage. As this thread has forced me to learn, a recent meta-analysis doesn't support its use (Blood Transfus 2017;15:318-24). No surprise there. But the quality of studies comprising the meta-analysis is poor, preliminary, and more data is sure to come. I guess few people in the US is using it as of yet, which was my original question. Thanks, everyone, for your comments and an interesting discussion. I learned lots!