A prospective, randomized controlled trial of fibrinogen concentrate (FC) plus standard of care versus standard of care alone in adult trauma patients with major bleeding or presumed major bleeding is developed to evaluate the efficacy and safety of prehospital administration of FC in trauma patients with suspected hypofibrinogenemia and active bleeding or presumed to be bleeding.
The main endpoints are:
1. Plasma fibrinogen levels in the first blood sample drawn at the patient's arrival at the trauma room and/or similar emergency bay dedicated to trauma and reanimation above the critical threshold of 2.0 g/l. As fibrinogen decreases early in trauma, its deficiency predicts massive bleeding and death.
2. Administration feasibility of FC within the prehospital setting.
Patients will be randomly assigned to receive either standard trauma care or standard trauma care plus administration of FC.

Start Date01 Jan 2025

Sponsor / Collaborator-

CTRI/2024/09/073878 / Not yet recruitingPhase 3

Evaluation of the effect of fibrinogen on peripartum hemorrhage in Placenta accreta spectrum (PAS) disorders, a double blind randomized controlled trial. - NIL

Start Date24 Sep 2024

Sponsor / Collaborator-

EUCTR2022-001759-17-DE / Not yet recruitingPhase 3

A multicenter, randomized, double-blind, placebo-controlled, parallel, phase 3 study to assess the efficacy and safety of fibrinogen concentrate (FGTW) in the management of bleeding in patients undergoing complex cardiac surgery (involving CPB)

Start Date15 Mar 2023

Sponsor / Collaborator

Laboratoire Français du Fractionnement et des Biotechnologies

100 Clinical Results associated with Fibrinogen Concentrate (Human)

100 Translational Medicine associated with Fibrinogen Concentrate (Human)

100 Patents (Medical) associated with Fibrinogen Concentrate (Human)

158

Literatures (Medical) associated with Fibrinogen Concentrate (Human)

01 Dec 2024·The American Journal of Surgery

Multicenter analysis of massive transfusion practices demonstrates variabilities across trauma centers in the Southwestern Surgical Congress

Article

Author: Regner, Justin ; Shaver, Courtney ; Hall, Chad

BACKGROUNDThis study's purpose is to investigate emergent blood (EB) usage, massive transfusion protocols (MTP), and the use of pharmacologic adjuncts to resuscitation across trauma centers in the Southwestern Surgical Congress (SWSC).METHODSAnonymous, voluntary 26-question survey conducted by the SWSC multicenter trials group. Descriptive statistical analysis was performed.RESULTS36 institutions across 14 states responded. EB is immediately available at 27 institutions. 53 % have LTOWB available. LTOWB is incorporated into MTP at 39 % of institutions and is the primary MTP product used at 4 centers. 65 % of institutions use thromboelastography to guide resuscitation. 70 % of institutions reported using TXA and 11 % used fibrinogen concentrate. 36 % of responding institutions routinely draw ionized calcium values. Four institutions have a calcium replacement protocol. Only 6 centers report redosing antibiotics during MTP.CONCLUSIONEB availability and MTP practices are evolving with variability across the SWSC. Pharmacologic therapies remain poorly incorporated into the MTP.

01 Dec 2024·BJA Open

Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy

Review

Author: Haas, Thorsten ; Erdoes, Gabor ; Koster, Andreas ; Levy, Jerrold H ; Steiner, Marie E ; Goobie, Susan M

Neonates, infants, and children undergoing major surgery or with trauma can develop severe coagulopathy perioperatively. Neonates and infants are at highest risk because their haemostatic system is not fully developed and underlying inherited bleeding disorders may not have been diagnosed before surgery. Historically, laboratory coagulation measurements have been used to diagnose and monitor coagulopathies. Contemporary dynamic monitoring strategies are evolving. Viscoelastic testing is increasingly being used to monitor coagulopathy, particularly in procedures with a high risk of bleeding. However, there is a lack of valid age-specific reference values for diagnosis and trigger or target values for appropriate therapeutic management. A promising screening tool of primary haemostasis that may be used to diagnose quantitative and qualitative platelet abnormalities is the in vitro closure time by platelet function analyser. Targeted individualised treatment strategies for haemostatic bleeding arising from inherited or acquired bleeding disorders may include measures such as tranexamic acid, administration of plasma, derived or recombinant factors such as fibrinogen concentrate, or allogeneic blood component transfusions (plasma, platelets, or cryoprecipitate). Herein we review current recommended perioperative guidelines, monitoring strategies, and treatment modalities for the paediatric patient with a coagulopathy. In the absence of data from adequately powered prospective studies, it is recommended that expert consensus be considered until additional research and validation of goal-directed perioperative bleeding management in paediatric patients is available.

01 Nov 2024·Heliyon

Reversal of dabigatran and apixaban-induced coagulopathy using idarucizumab, fibrinogen, and prothrombin complex concentrate: A case report

Article

Author: Costantini, Ilaria ; Losso, Lorenzo ; Bacchion, Matilde ; Drezza, Lucia ; Carollo, Massimo ; Morando, Elia ; Ricci, Giorgio

This case report examines the combined use of fibrinogen concentrate, four-factor prothrombin complex concentrate (PCC), and idarucizumab, a specific antidote for dabigatran, to reverse the anticoagulant effects of dabigatran and apixaban-induced coagulopathy. An 86-year-old patient, receiving apixaban therapy, presented to the Emergency Department after intentionally ingesting 50 tablets of dabigatran. The combination therapy contributed to the rapid normalization of coagulation parameters and stabilization of the patient's clinical status without subsequent thromboembolic complications. This case adds to the limited evidence on the effectiveness and safety of combining PCC with idarucizumab in cases of multiple anticoagulant intoxication.

News (Medical) associated with Fibrinogen Concentrate (Human)

02 Aug 2024

·www.prnewswire.com

FDA Approves Additional Indication for Fibryga® for Fibrinogen Supplementation in Bleeding Patients with Acquired Fibrinogen Deficiency, Potentially Ushering in a New Standard of Care

PARAMUS, N.J, Aug. 1, 2024 /PRNewswire/ -- Octapharma USA, Inc. has announced the expanded approval of fibryga®, Fibrinogen (Human) Lyophilized Powder for Reconstitution, for fibrinogen replacement in bleeding patients with acquired fibrinogen deficiency (AFD) by the U.S. Food and Drug Administration (FDA). As the first and only on-demand, virus-inactivated, human plasma-derived fibrinogen concentrate option with this approval, fibryga represents a rapid and more precise option for severe bleeding scenarios than the current standard of care (cryoprecipitate). Fibrinogen plays an important role in coagulation and blood clotting in emergency and surgical settings. Fibrinogen is the first coagulation factor to drop to critically low levels during severe bleeding episodes. Rapid replenishment of fibrinogen is essential for achieving hemostasis in bleeding patients. Acquired fibrinogen deficiency (AFD) often results from severe bleeding and can impair blood clot formation, increasing the risk of ongoing hemorrhage in patients. Cryoprecipitate, which was introduced in 1964, comes with significant drawbacks, including long thawing and preparation processes, variable levels of fibrinogen, inclusion of additional coagulation-dependent components, and a higher risk of viral transmission. The approval of fibryga for AFD is a major advancement from the current standard of care. As a lyophilized powder, it can be stored at room temperature or refrigerated and can be quickly reconstituted at the point of patient care. It's precise and delivers a highly purified and consistent amount of fibrinogen for accurate treatment. "In the surgical theater, time matters. And confidence matters. This expanded FDA approval of fibryga represents a major step forward in our commitment to redefining the standard of care for patients experiencing major bleeding. It provides an important option for providers who must act urgently," said Flemming Nielsen, President, Octapharma USA, Inc. "We are proud to be the first to offer this therapeutic advancement—and a new standard of care—to hospitals, anesthesiologists, surgeons, OB/GYNs, and patients across the United States." The expanded FDA approval of fibryga was based on the FIBRES [FIBrinogen REplenishment in Surgery] study published in JAMA, which was a head-to-head, multicenter, randomized clinical trial in 735 patients, demonstrating that fibrinogen concentrate was non-inferior to cryoprecipitate and may be used instead of cryoprecipitate for the treatment of bleeding related to AFD. Fibryga has already received regulatory approval for the treatment of AFD in both the European Union in 2019 and Canada in 2020. Today's approval marks the third FDA approval received to date for fibryga. In 2017, the FDA granted an approval for acute bleeding episodes in adults and adolescents with congenital fibrinogen deficiency, including afibrinogenemia and hypofibrinogenemia. A second was received in 2020 for pediatric patients under 12 years for treatment of acute bleeding episodes in congenital fibrinogen deficiency. "The recent FDA approval is the result of years of dedicated research and development in fibrinogen replacement," commented Huub Kreuwel, Ph.D., VP of Medical Affairs at Octapharma USA, Inc. "Fibryga's expanded indication will allow practitioners and health systems to support a broader range of patients with serious bleeding complications who require fibrinogen replacement therapy." The medical community has welcomed this approval as a significant advancement in patient care for those with AFD. "This first-in-class FDA approval for fibryga, a fibrinogen concentrate with an expanded indication to treat bleeding patients urgently in need of fibrinogen replacement, is an important step toward improving patient safety and outcomes. Compared to cryoprecipitate, fibrinogen concentrate allows for targeted dosing and faster treatment of low fibrinogen in maternal hemorrhage," states John Kowalczyk, MD, and Michaela Farber, MD, MS, Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Octapharma is committed to working closely with healthcare providers and patient organizations to ensure broad access to fibryga for those who can benefit from it. For more information about the FIBRES study, please review our journal publication: Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery The FIBRES Randomized Clinical Trial Indications and Important Safety Information for fibryga Indications and Usage Fibryga is a human fibrinogen concentrate indicated for fibrinogen supplementation in bleeding patients with acquired fibrinogen deficiency and in treatment of acute bleeding episodes in patients with congenital fibrinogen deficiency, including afibrinogenemia and hypofibrinogenemia. Fibryga is not indicated for dysfibrinogenemia. Contraindications Fibryga is contraindicated in individuals who have manifested severe immediate hypersensitivity reactions, including anaphylaxis, to fibryga or its components (Sodium Citrate Dihydrate; Glycine; L-Arginine Hydrochloride). Warnings and Precautions Monitor patients for early signs of hypersensitivity or allergic reactions. If necessary, discontinue administration and institute appropriate treatment. Thrombotic events have been reported in patients receiving fibryga. Treatment with human fibrinogen concentrate has been associated with thrombosis at target plasma fibrinogen levels that were below 150 mg/dL. The thrombotic risks may be greater when the target fibrinogen plasma level is 150 mg/dL. Weigh the benefits of administration versus the risks of thrombosis. Fibryga is made from pooled human plasma. Products made from human plasma may contain infectious agents, e.g., viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent. Adverse Reactions The most serious adverse reactions observed with fibryga are thromboembolic episodes and anaphylactic-type reactions. The most common adverse reactions observed in clinical studies with fibryga in acquired fibrinogen deficiency (>5% of patients) were abnormal hepatic function, acute kidney injury, anemia, atrial fibrillation, delirium and renal failure. The most common adverse reactions observed in clinical studies with fibryga in congenital fibrinogen deficiency (>5% of patients) were nausea, vomiting, pyrexia (fever) and thrombocytosis. Please see fibryga full Prescribing Information. For more information about fibryga, please visit fibrygausa.com. About Octapharma and Octapharma USA Headquartered in Lachen, Switzerland, Octapharma is one of the largest human protein manufacturers in the world, developing and producing human proteins from human plasma and human cell lines. Octapharma employs nearly 12,000 employees worldwide to support the treatment of patients in 118 countries with products across three therapeutic areas: Immunotherapy, Hematology, and Critical Care. Octapharma has seven R&D sites and five state-of-the-art manufacturing facilities in Austria, France, Germany and Sweden, and operates more than 190 plasma donation centers across Europe and the US. Octapharma has 40 years of experience in patient care. The company's American subsidiary, Octapharma USA, Inc., is located in Paramus, N.J. For more information, please visit octapharmausa.com. SOURCE Octapharma

Drug Approval

14 Feb 2024

·www.fiercepharma.com

Grifols readies US, EU approval push for blood clot treatment after phase 3 success

BT524 can be administered to “patients on the operating table immediately," Grifols explained. Grifols is readying an approval run at U.S. and European regulators on the back of a phase 3 win for the Spanish plasma medicine producer's concentrated form of a blood clotting factor. The product, dubbed BT524, is a concentrated form of fibrinogen, a glycoprotein that is essential for blood clot formation and stops excessive bleeding resulting from injuries or surgery. Grifols was testing BT524 in a late-stage study of patients with acquired fibrinogen deficiency (AFD), which it described as an “underserved growth market.” The Barcelona, Spain-based company announced this morning that the product had met the study’s primary endpoint, demonstrating its noninferiority to standard of care when it came to reducing blood loss in patients with AFD who underwent spinal or abdominal surgery, while also “maintaining an excellent safety profile.” Specifically, mean blood loss was 1,444 mL among the BT524 cohort compared with 1,735 mL among patients who received standard of care. It meant patients receiving Grifols’ product lost an average of 291 mL less blood. AFD usually occurs during surgery when a patient’s body contains insufficient fibrinogen to arrest bleeding. It is typically treated with a plasma extract called cryoprecipitate or fresh frozen plasma, which both contain fibrinogen. However, both of these treatment options contain various other unneeded proteins and elements, meaning that large volumes are required to ensure the patient receives sufficient fibrinogen, Grifols explained in the release. They also need to be thawed before use, which is not only time-consuming but can put patients’ lives at risk, the company added. In contrast, BT524 can be administered to “patients on the operating table immediately,” who will only receive the fibrinogen necessary to prevent hemorrhaging, Grifols explained. The company’s plan is to kick off the approval process in both Europe and the U.S. in the fourth quarter of the year. If successful, it would mark the first fibrinogen concentrate approved for AFD in the U.S., Grifols noted. “The positive results for fibrinogen are an important milestone and strengthen a Grifols innovation strategy that’s diversified across plasma and non-plasma, balanced between internal and external investments, and includes both shorter- and longer-term development cycles,” Grifols’ chief operating officer, Victor Grifols Deu, said in the release. While Grifols has its eye on the first fibrinogen concentrate approval for AFD in the U.S., its competitors have had more luck getting their own versions to market for congenital fibrinogen deficiency. CSL Behring got RiaSTAP approved in that indication as far back as 2009, while Switzerland’s Octapharma followed suit with Fibryga in 2017. Since then, Fibryga has also received approval to treat AFD across Europe off the back of a phase 2 study. Meanwhile, Grifols is in the midst of an ongoing legal battle with Gotham City Research after the New York hedge fund accused the company of wrongful accounting practices.

Drug ApprovalClinical ResultPhase 3Phase 2

14 Feb 2024

·pipelinereview.com

Biotest successfully meets primary endpoint in phase III trial with Fibrinogen concentrate

DREIEICH, Germany I February 14, 2024 I Biotest announced today that the AdFIrst ( Ad justed FI brinogen r eplacement st rategy) phase III trial met its primary endpoint, demonstrating that Fibrinogen concentrate is non-inferior to standard of care in reducing intraoperative blood loss in patients with acquired fibrinogen deficiency undergoing planned major spinal or abdominal surgery. Mean blood loss measured in the two treatment groups were 1,444 mL in the Fibrinogen concentrate group versus 1,735 mL in the standard of care group, resulting in a reduction of blood loss of 291 mL in patients treated with fibrinogen concentrate. The AdFIrst trial was a prospective, randomised, active-controlled, multicentre phase III trial involving 222 patients undergoing elective spine or abdominal surgery. The main purpose of this phase III trial was to demonstrate that Fibrinogen concentrate improves clotting function and reduces blood loss in the management of severe haemorrhage as effectively as standard of care. The efficacy and safety of Fibrinogen concentrate was compared with the centres’ standard of care, either fresh frozen plasma or cryoprecipitate. “We are very pleased to have successfully completed this clinical trial. Our focus is now on preparing the marketing authorization applications,” said Dr Silke Aigner, Senior Director Clinical Strategy & Development at Biotest AG. “There is a high medical need for additional fibrinogen concentrates to ensure availability of fibrinogen for more patients in this severe medical situation.” The results of Biotest’s two clinical trials, the AdFIrst trial and the completed phase I/III trial in patients with congenital fibrinogen deficiency, will serve as the basis for approval of Fibrinogen concentrate for the treatment of patients with congenital and acquired fibrinogen deficiency. Initial applications for marketing authorisations are planned in Europe and US. This would be the first fibrinogen concentrate approved for an acquired fibrinogen deficiency indication in the US. In much of the world today, standard of care to control severe surgical bleeding is fibrinogen replacement through cryoprecipitate or fresh frozen plasma, treatments that contain not only fibrinogen but also other proteins and elements that a patient might not need. Worldwide, there are only two other fibrinogen concentrates authorised in multiple countries for acquired fibrinogen deficiency, but they are not approved in the US. As part of the Grifols Group, Biotest intends to play a leading role in making this therapy available in a broader patient population. Compared with congenital fibrinogen deficiency, where efficacy has been demonstrated in an earlier trial, the market size for the treatment of acquired fibrinogen deficiency is many times larger. There is a worldwide market potential of USD 800 million. The market in the US, in particular, has great development potential, as therapy with fibrinogen concentrate is not established there. Detailed results of the trial will be presented later this year. About Biotest’s Fibrinogen concentrate The newly developed manufacturing process of the fibrinogen concentrate leads to high-purity fibrinogen with a defined concentration, high level of viral safety and good solubility. About AdFIrst trial no. 995 The AdFIrst trial was a prospective, active-controlled, multicentre phase III trial investigating the efficacy and safety of the Fibrinogen concentrate (BT524) in patients with acquired fibrinogen deficiency. Patients who had high blood loss during planned spinal or abdominal surgery were randomized 1:1 to treatment with Fibrinogen concentrate (BT524) or fresh frozen plasma (FFP)/Cryoprecipitate. To evaluate the efficacy of BT524, blood loss was compared between the both treatment options. Further information about the trial design can be found at www.clinicaltrialsregister.eu (EudraCT number: 2017-001163-20). About fibrinogen and fibrinogen deficiency Fibrinogen is a blood clotting factor that is produced in the liver. It plays a key role in primary haemostasis (stopping blood loss from bleeding wounds) and wound healing. In case of a lack or shortage of fibrinogen blood’s ability to clot is impaired which leads to a much greater risk of bleeding and delayed haemostasis. The fibrinogen concentrate alternatives fresh frozen plasma (FFP) and cryoprecipitate contain variable amounts of fibrinogen and must be thawed prior to treatment. The defined amount of fibrinogen in the fibrinogen concentrate will allow a tailor-made, patient specific and highly effective therapy. About Biotest Biotest is a provider of biological therapeutics derived from human plasma. With a value added chain that extends from pre-clinical and clinical development to worldwide sales, Biotest has specialised primarily in the areas of clinical immunology, haematology and intensive care medicine. Biotest develops and markets immunoglobulins, coagulation factors and albumin based on human blood plasma. These are used for diseases of the immune and haematopoietic systems. Biotest has more than 2,400 employees worldwide. The ordinary and preference shares of Biotest AG are listed in the Prime Standard on the German stock exchange. Since May 2022, Biotest has been a part of the Grifols Group, based in Barcelona, Spain (www.grifols.com). SOURCE: Biotest

Phase 3Clinical Result

100 Deals associated with Fibrinogen Concentrate (Human)

R&D Status

Approved

10 top approved records.

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Indication	Country/Location	Organization	Date
Hemorrhage	US	CSL Behring GmbH	16 Jan 2009

Developing

10 top R&D records.

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Indication	Highest Phase	Country/Location	Organization	Date
Coronary Artery Disease	Phase 1	US	CSL Behring LLC	01 Jan 2011
Heart Valve Diseases	Phase 1	US	CSL Behring LLC	01 Jan 2011
Acquired fibrinogen deficiency	Phase 1	-	CSL Behring LLC	01 Oct 2009
Afibrinogenemia	Phase 1	-	CSL Behring LLC	01 Oct 2009
Hemorrhage	Phase 1	-	CSL Behring LLC	01 Oct 2009
Heart Diseases	Preclinical	BR	CSL Behring LLC	01 Aug 2010
Acquired fibrinogen deficiency	Preclinical	-	CSL Behring LLC	01 Oct 2009
Afibrinogenemia	Preclinical	-	CSL Behring LLC	01 Oct 2009
Hemorrhage	Preclinical	-	CSL Behring LLC	01 Oct 2009
Aortic Aneurysm	Preclinical	DE	CSL Behring LLC	01 Jun 2008

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT03932240 (CTgov)	Phase 3	-	36	Fibrinogen Concentrate (FC) (Fibrinogen Concentrate (FC))	ghwawiobsf(wlmemxngzz) = xlzrclfmta zdqaucadgw (ftblketwnh, zemmpjctoa - bvfwloqlia) View more	-	20 Mar 2023
				Cryoprecipitate (Cryoprecipitate)	ghwawiobsf(wlmemxngzz) = ywdxbdbxaw zdqaucadgw (ftblketwnh, ibrpsawsqr - awwggqvljb) View more
NCT02822599 (RiaSTAP, CTgov)	Phase 4	Hemorrhage \| Afibrinogenemia	30	RiaStAP (RiaSTAP)	hgaywuepng(jydtcllszm) = nthekegeed ecoppjmevy (kviougnocm, hkeicxinpy - tgawuwzbuq) View more	-	16 Sep 2021
				Saline (Saline)	hgaywuepng(jydtcllszm) = rasylkycoi ecoppjmevy (kviougnocm, wtclydqzij - cnmmfedfed) View more
ISTH2020	Not Applicable	Thrombocytopenia	-	Fibrinogen concentrate	dumhogepzo(jokpbneafb) = owurinsocn kogeqposer (dmtjizmvxy )	-	12 Jul 2020
NCT01623531 (CTgov)	Phase 3	Intraoperative Complications	62	Fibrinogen (RiaSTAP)	abvabxiupp(eaynwfyhmj) = nslamqhtrk pufxptxsgv (cpdjfiawup, mshibjnzqi - lxzbqvnbdt) View more	-	22 May 2020
				Fibrinogen (Intravenous Saline)	abvabxiupp(eaynwfyhmj) = yxbicwaeye pufxptxsgv (cpdjfiawup, qabbmgwpvs - gjwvrfjiqb) View more
Pubmed \| Acta Anaesthesiol Scand	Not Applicable	-	62	Fibrinogen concentrate	qpbndglklb(olcmrobpte) = yltiraqqsd njgyhnfxtz (wlsxfqqkfh )	-	01 May 2020
				Placebo	qpbndglklb(olcmrobpte) = fzsjwxbyhe njgyhnfxtz (wlsxfqqkfh )
ESC2018	Not Applicable	-	299	Fibrinogen concentrate	fmokbozgwc(htqwbxohtk) = jarugxfzsp gwjznybguw (gnfgucljje ) View more	Positive	27 Aug 2018
				Fibrinogen concentrate	fmokbozgwc(htqwbxohtk) = ijgisdxczp gwjznybguw (gnfgucljje ) View more
NCT02540434 (TOP-CLOT, CTgov)	Not Applicable	Blood Coagulation Disorders	19	RiaSTAP+ROTEM (RiaSTAP Arm)	lbgwycifnr(posxwbiyvi) = uueorzplav ntdlahxxqh (svcrmremyz, fommrpgxhp - pmyvtojbcl) View more	-	12 May 2017
				Cryoprecipitate (Cryopreciptiate Arm)	lbgwycifnr(posxwbiyvi) = edvgdxrogv ntdlahxxqh (svcrmremyz, udwehxxlov - hhqdzlemve) View more
EUCTR2009-018086-12-NL \| NCT01124981 (Pubmed \| J Coll Physicians Surg Pak)	Phase 2/3	Blood Loss, Surgical	120	Fibrinogen concentrate	(epluhgdimi) = uqxbhilllw vyhcydhzrv (dsaraacddf )	Negative	21 Feb 2017
				Placebo	(epluhgdimi) = pcczbdhhvc vyhcydhzrv (dsaraacddf )
NCT01575756 (CTgov)	Phase 2	Acquired fibrinogen deficiency \| Afibrinogenemia	22	RiaSTAP(TM)+FIBRYGA (Pharmacokinetic (PK)-Per Protocol Dataset)	hhghcnkxks(jtbqhgqlok) = azynseuzbe oiuxtwphdi (wkbxkctcgs, obcxtjqyss - krhsclpral)	-	30 Nov 2016
				FIBRYGA (Octafibrin/FIBRYGA®)	fkaufonecu(fljaputcmv) = euqzvyhmwn mqrxqesuzs (othtcobywp, nbbevmidim - urfeeuxvty) View more
NCT00968045 (Pubmed \| Vet Anaesth Analg)	Not Applicable	-	48	Fibrinogen concentrate	(avgqfmfvfz) = ezatohvnit bukmewcuos (wircfxacsh )	-	01 Feb 2016
				Placebo	(avgqfmfvfz) = aylqbzzeom bukmewcuos (wircfxacsh )

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