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SIR 2025

Venous Interventions

Scientific Session

Featured Abstract

Session: Pulmonary Embolism

Fibrinogen Monitoring Does Not Significantly Reduce Rates of Bleeding Complications During Catheter-Directed Thrombolysis

Monday, March 31, 2025
3:00 PM – 3:09 PM CT
Location: Music City Center, 201 AB
Purpose: Fibrinogen levels are frequently utilized to assess hemorrhagic risk and guide tPA dosing during catheter-directed thrombolysis (CDT). However, their clinical utility and predictive value for bleeding complications remain underexplored. This study aims to evaluate the impact of fibrinogen monitoring on bleeding complications and the rates of premature tPA cessation which may lead to poor patient outcomes.

Materials and Methods: This single-institution retrospective study examined patients who underwent CDT for arterial, venous, or pulmonary thrombosis from 1/2011-1/2023. Information on tPA dose, duration, premature cessations, labs, hemorrhage, complications, and outcomes were obtained via chart review. Rates of significant hemorrhages (defined by clinical presentation, CT scan, or transfusion requirements) and premature tPA cessation were compared in patients with and without routine fibrinogen monitoring.

Results: The analysis included 355 cases: 225 without and 130 with routine fibrinogen monitoring. Statistical analysis revealed no significant difference in bleeding rates among the two groups, at 3.55% (8 cases) in the control and 3.07% (4 cases) in the fibrinogen group (p=1.0). However, premature tPA stoppage occurred more frequently in the fibrinogen group (16.9%, 22 cases) compared to the control group (2.22%, 5 cases). Of the 27 total cases of premature tPA cessation, 22 (81.5%) had residual clots requiring further interventions (thrombectomy, balloon maceration, stenting), 5 of which (22.7%) had unsuccessful procedure outcomes (persistent thrombus) despite additional therapy. Cryoprecipitate was given in 20 of 27 cases (74%), ranging from 1-4 units for an average of 1.5 units/case.

Conclusion: This study demonstrates that fibrinogen monitoring does not significantly reduce bleeding risk but is linked to higher rates of premature tPA cessation in stable patients, which leads to worse clinical outcomes. Most cases with premature tPA stoppage required cryoprecipitate and additional interventions for clot resolution. Overall, these findings suggest that while fibrinogen has limited clinical utility in assessing hemorrhagic risk during CDT, it does lead to more tPA cessation and worse clinical outcomes raising questions about whether routine fibrinogen monitoring is necessary in the perioperative management of CDT.