• Toshko Lissitchkov, Bella Madan, Claudia Djambas Khayat, Nadezhda Zozulya, Cecil Ross, Mehran Karimi, Kaan Kavakli, Guillermo R De Angulo, Abdulkareem Almomen, Bruce A Schwartz, Cristina Solomon, Sigurd Knaub, and Flora Peyvandi.
• Department of Hemorrhagic Diathesis and Anemia, Specialized Hospital for Active Treatment (SHAT) "Joan Pavel,", Sofia, Bulgaria.
• Transfusion. 2018 Feb 1; 58 (2): 413-422.

BackgroundFibrinogen concentrate is the preferred choice for fibrinogen replacement in congenital fibrinogen deficiency. This study investigated hemostatic efficacy of a new plasma-derived, double virus-inactivated (using two dedicated virus inactivation/elimination steps) human fibrinogen concentrate for on-demand treatment of bleeding episodes (BEs) and surgical prophylaxis.Study Design And MethodsIn this planned interim analysis of a prospective, multinational Phase III study (NCT02267226), 13 patients with afibrinogenemia (≥12 years) received fibrinogen concentrate (FIBRYGA, Octapharma AG). Hemostatic efficacy was assessed by investigators and an independent data monitoring and endpoint adjudication committee (IDMEAC) using objective four-point criteria and by thromboelastometry maximum clot firmness (MCF).ResultsFibrinogen concentrate was used on-demand to treat 23 BEs in 11 patients, with 21 (91.3%) requiring a single infusion only. Treatment success was 95.7% (90% confidence interval [CI], 0.81-1.00; assessment missing for one BE) by investigators and 100% (90% CI, 0.88-1.00) by IDMEAC. Mean MCF increased significantly from 0.0 to 6.5 mm (95% CI, 5.65-7.40; p < 0.0001) at 1 hour postinfusion of a median (range) dose of 58.8 (33.9-101.7) mg/kg per BE. Four patients received fibrinogen concentrate as surgical prophylaxis, with intraoperative and postoperative treatment success rated 100% (90% CI, 0.50-1.00) by investigators and IDMEAC (median [range] dose per surgery 93.5 [34.1-225.4] mg/kg). No additional hemostatic interventions were required. No deaths, thromboses, or seroconversions were reported.ConclusionThese data showed that the new fibrinogen concentrate was efficacious for on-demand treatment of acute bleeding and surgical prophylaxis in congenital afibrinogenemia patients.© 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

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