Although the FDA approved CSL-Behring’s RiaSTAP, human plasma-derived fibrinogen concentrate in 2009, it seems most facilities continue to use cryoprecipitate to treat hypofibinogenemia, dysfibrinogenemia, and afibrinogenemia. Has your institution switched to RiaSTAP? Why, or why not?
For the answer, see this reference provided by George’s UAB colleague, pathologist Lawrence A. Williams III:
“After adjusting for 28% wastage and technologist salary, CRYO cost is $414/5-unit pool. Depending on the dose, FC is more expensive by $976-$1303. To be competitive with cryo, FC cost must decrease by 44% or be shown to save 025–066 ICU days. Of the 30 survey replies, 967% of US centres do not use FC for acquired bleeding with the top three reasons being cost (30%), off-label usage (27%) and insufficient evidence for usage (20%). Only 47% are willing to pay more for FC, with $437/g as the median amount.”
Okerberg CK, Williams LA 3rd, Kilgore ML, Kim CH, Marques MB, Schwartz J, Pham HP. Cryoprecipitate AHF vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients–an economic evaluation. Vox Sang. 2016;111:292–8.
Two more citations from
Two more citations from recent publications: “The RCT showed a possible increased functional improvement of haemostasis after cryoprecipitate therapy compared to fibrinogen concentrate. Jensen NH, Stensballe J, Afshari A. Comparing efficacy and safety of fibrinogen concentrate to cryoprecipitate in bleeding patients: a systematic review. Acta Anaesthesiol Scand. 2016;60:1033–42, and “The LI 60 was significantly improved (fibrinolysis attenuated) after cryoprecipitate supplementation compared to TPA alone and compared to FXIII and fibrinogen concentrate… In addition, cryoprecipitate demonstrated the least variability in the attenuation of hyperfibrinolysis among 10 healthy subjects, compared to FXIII and fibrinogen concentrate.” Cushing MM, Fitzgerald MM, Harris RM, Asmis LM, Haas T. Influence of cryoprecipitate, factor XIII, and fibrinogen concentrate on hyperfibrinolysis. Transfusion. 2017. doi: 10.1111/trf.14259. [Epub ahead of print]