Background: Intracranial hemorrhage is characterized by the blood vessel rupture and subsequent
hematoma expansion. It is the least treatable stroke subtype, resulting in higher morbidity and mortality
per incidence than ischemic stroke. Recent studies have observed lower than normal levels of plasma fibrinogen
in patients of intracerebral hemorrhage. Furthermore, in other cases of severe hemorrhage, plasma
fibrinogen levels have been identified as an indicator of prognosis. Current clinical management of cerebral
hemorrhage includes adjunctive therapies and possible surgical evacuation. However, a possible therapeutic
target for intracranial hemorrhage is fibrinogen. During intracranial hemorrhage with hematoma expansion,
fibrinogen levels are rapidly depleted and thus are in need of replacement. Maintaining high levels of fibrinogen
can promote rapid clotting and reduction of hematoma expansion.
Objectives: Within this review, we examine the role of fibrinogen in intracranial hemorrhage and evaluate
the use of fibrinogen replacement therapies for maintaining normal levels of this key hemostatic protein.
The pros and cons are discussed and an opinion of the most appropriate fibrinogen replacement therapy for
intracranial hemorrhage is made.
Conclusion: It is concluded that fibrinogen concentrate seems to be the most suitable therapy for elevating
plasma fibrinogen for the treatment of intracranial hemorrhage with hematoma expansion.