WHAT TO DO ABOUT TOO MUCH FIBRINOGEN

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What is the treatment for hyperfibrinogenemia?
—James Patel, MD, Stockton, Calif.

Plasma fibrinogen is increasingly recognized as an independent risk factor for stroke and ischemic heart disease (Ann NY Acad Sci. 2001; 936:469-479 and N Engl J Med. 1984;311:501-505). Levels may vary with age, genetics, and the presence of pathologic conditions, such as tobacco use, diabetes, hypertension, and obesity. Definitive treatment for hyperfibrinogenemia has yet to be established. One trial showed a significant reduction in levels using a combination of folic acid, pyridoxine, and vitamin B12 over the course of one month (Metabolism. 2001;50:131-134).

A randomized, double-blind, placebo-controlled trial showed a statistically significant reduction in fibrinogen levels using ticlopidine (Ticlid) in 37 patients suffering from polycythemia vera and related hyperfibrinogenemia (Acta Haematol. 1991;85:113-118). Finally, several trials have looked at the use of fibrates, with mixed results (Rev Invest Clin. 1998;50:491-496 and Atherosclerosis. 1988;71:113-119).
—Christopher Ruser, MD (112-15)

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