Thromboembolic events in patients with severe inherited fibrinogen deficiency

Amihai Rottenstreich, Avigal Lask, Lilliana Schliamser, Ariella Zivelin, Uri Seligsohn, Yosef Kalish*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Inherited afibrinogenemia and hypofibrinogenemia are rare bleeding disorders characterized by markedly reduced levels of fibrinogen in blood. Thrombotic complications in these disorders have been rarely described. We performed a multicenter retrospective study and reviewed the occurrence of thrombotic complications among patients with inherited fibrinogen deficiency. Cases were identified during a review of medical records of all patients with inherited fibrinogen deficiency followed at three different university hospitals in Israel. Nine patients were included in this study: five were afibrinogenemic and four hypofibrinogenemic. There were seven thrombotic events, mostly venous, that occurred in four out of nine patients (44 %). All thrombotic events occurred in afibrinogenemic patients. Mean age at the time of thrombosis was 45 (range 28–61) years. Thrombophilic evaluation performed was negative in all cases. At the time of thrombosis in five out of seven (71.4 %) events, fibrinogen replacement therapy was concurrently given. Therapeutic approach was different among patients ranging from supportive therapy alone, antiplatelet agents and anticoagulant therapy with the concurrent administration of fibrinogen replacement therapy. This study discloses a high rate of thrombosis in patients with afibrinogenemia. Events were both venous and arterial and may be recurrent. Management is highly problematic due to the precarious balance between bleeding and thrombotic risk in these patients. Fibrinogen replacement therapy should be cautiously used in these patients as most thrombotic events followed the administration of fibrinogen replacement therapy. Larger cohorts are warranted to better characterize the best management strategy in these paradoxical events.

Original languageEnglish
Pages (from-to)261-266
Number of pages6
JournalJournal of Thrombosis and Thrombolysis
Issue number2
StatePublished - 1 Aug 2016


  • Afibrinogenemia
  • Deep vein thrombosis
  • Fibrinogen replacement therapy
  • Myocardial infarction
  • Renal vein thrombosis
  • Thrombosis


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