Management of congenital quantitative fibrinogen disorders: a Delphi consensus

Haemophilia. 2016 Nov;22(6):898-905. doi: 10.1111/hae.13061. Epub 2016 Sep 19.


Introduction: No evidence-based guidelines for the management of patients suffering from afibrinogenaemia and hypofibrinogenaemia are available.

Aim and method: The aim of this study was to harmonize patient's care among invited haemophilia experts from Belgium, France and Switzerland. A Delphi-like methodology was used to reach a consensus on: prophylaxis, bleeding, surgery, pregnancy and thrombosis management.

Results: The main final statements are as follows: (i) a secondary fibrinogen prophylaxis should be started after a first life-threatening bleeding in patients with afibrinogenaemia; (ii) during prophylaxis the target trough fibrinogen level should be 0.5 g L-1 ; (iii) if an adaptation of dosage is required, the frequency of infusions rather than the fibrinogen amount should be modified; (iv) afibrinogenaemic patients undergoing a surgery at high bleeding risk should receive fibrinogen concentrates regardless of the personal or family history of bleeding; (v) moderate hypofibrinogenaemic patients (i.e. ≥0.5 g L-1 ) without previous bleeding (despite haemostatic challenges) undergoing a surgery at low bleeding risk may not receive fibrinogen concentrates as prophylaxis; (vi) monitoring the trough fibrinogen levels should be performed at least once a month throughout the pregnancy and a foetal growth and placenta development close monitoring by ultrasound is recommended; (vii) fibrinogen replacement should be started concomitantly to the introduction of anticoagulation in afibrinogenaemic patients suffering from a venous thromboembolic event; and (viii) low-molecular-weight heparin is the anticoagulant of choice in case of venous thromboembolism.

Conclusion: The results of this initiative should help clinicians in the difficult management of patients with congenital fibrinogen disorders.

Keywords: afibrinogenaemia; bleeding; fibrinogen; hypofibrinogenaemia; pregnancy; thrombosis.

Publication types

  • Multicenter Study

MeSH terms

  • Afibrinogenemia / complications*
  • Congenital Abnormalities / immunology*
  • Disease Management
  • Female
  • Fibrinogen / therapeutic use*
  • Hemorrhage / drug therapy*
  • Humans
  • Pregnancy


  • Fibrinogen