Fibrinogen Test — Plasma Fibrinogen and Coagulation

Fibrinogen Test — Plasma Fibrinogen and Coagulation — scientific infographic poster

Fibrinogen is a protein produced by the liver that helps blood clots form. Thrombin cleaves it into fibrin, which polymerizes into the clot network, and it also acts as a pro-inflammatory signalling molecule in many diseases. The plasma fibrinogen test measures how much is in the blood; it is ordered for clotting problems such as excessive bleeding, it is one of the components of the disseminated intravascular coagulation (DIC) score, and in large cohort studies higher levels track with heart disease and stroke.

Table of Contents

  1. What Is Fibrinogen
  2. How the Test Is Performed
  3. Reference Ranges and Published Thresholds
  4. Fibrinogen in DIC and Hyperfibrinolysis
  5. Fibrinogen as an Acute-Phase Reactant
  6. Fibrinogen and Cardiovascular Risk
  7. Liver Disease and Fibrinogen
  8. Treatment: Fibrinogen Replacement
  9. Interpretation Points From the Research
  10. Key Research Papers
  11. Connections
  12. Featured Videos

What Is Fibrinogen

Fibrinogen is a protein produced by the liver; it helps stop bleeding by helping blood clots to form (MedlinePlus). Each molecule is built from two sets of three chains — Aα, Bβ and γ — joined by disulfide bridges, with two outer D domains connected to a central E domain (Mosesson 2005).

Fibrinogen as a coagulation factor (Factor I): Fibrin forms after thrombin cleaves fibrinopeptide A from the fibrinogen Aα chains, which starts fibrin polymerization. Double-stranded fibrils assemble, branch and associate laterally into a clot network, and factor XIII (XIIIa) then covalently cross-links pairs of γ chains (Mosesson 2005).

Fibrinogen and inflammation: Fibrinogen is also an acute-phase reactant (Toh 2016), and MedlinePlus lists infection and inflammation among the causes of abnormal results. In 16 intensive-care patients with COVID-19 acute respiratory distress syndrome, fibrinogen was markedly raised and its level was associated with interleukin-6 (Ranucci 2020). A 2012 review describes fibrinogen as a signalling molecule with a pro-inflammatory role reported in vascular wall disease, stroke, multiple sclerosis, Alzheimer's disease, rheumatoid arthritis, bacterial infection, colitis, lung and kidney fibrosis and several types of cancer (Davalos 2012).

Conditions that reduce fibrinogen: MedlinePlus lists the body using up too much fibrinogen (as in DIC), fibrinogen deficiency present from birth or acquired later, breakdown of fibrin (fibrinolysis) and heavy bleeding. Congenital fibrinogen disorders include afibrinogenemia, hypofibrinogenemia, dysfibrinogenemia and hypodysfibrinogenemia (Casini 2025).

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How the Test Is Performed

A blood sample is needed, and no special preparation is required (MedlinePlus).

Clauss Method

PT-Derived Fibrinogen

Immunologic (Antigen) Assays

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Reference Ranges and Published Thresholds

MedlinePlus gives a normal range of 200 to 400 mg/dL (2.0 to 4.0 g/L) and notes that normal value ranges may vary slightly among laboratories, so a result is read against the reporting laboratory's own range.

Fibrinogen — Adults mg/dL (MedlinePlus)

BELOW RANGE: <200 mg/dL
NORMAL: 200–400 mg/dL
ABOVE RANGE: >400 mg/dL

Pregnancy: In 391 women with uncomplicated pregnancies, fibrinogen increased markedly, and the authors conclude that gestational-age-specific reference values are essential for interpreting it during pregnancy, delivery and the puerperium (Szecsi 2010). In a Danish cohort of 55 healthy pregnant women, fibrinogen rose significantly from the second to the third trimester (Hansen 2011). A 2022 review describes a two- to three-fold increase in fibrinogen in normal pregnancy (Erez 2022).

Thresholds Used in Published Scores and Guidelines

Cardiovascular risk: The Northwick Park Heart Study and the Fibrinogen Studies Collaboration reported risk rising with fibrinogen level; the collaboration found no evidence of a threshold within the range of usual fibrinogen levels studied (see Fibrinogen and Cardiovascular Risk).

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Fibrinogen in DIC and Hyperfibrinolysis

MedlinePlus lists DIC and fibrinolysis among the causes of a low fibrinogen result.

Disseminated Intravascular Coagulation

DIC is a syndrome of systemic intravascular activation of coagulation that leads to widespread deposition of fibrin in the circulation (Levi 2013). Sustained thrombin generation leads to consumption of both pro- and anticoagulant factors (Toh 2016). The laboratory picture commonly described is a prolonged prothrombin time (PT) and partial thromboplastin time, a low platelet count, low fibrinogen and raised D-dimer (Erez 2022).

Obstetric DIC

Placental abruption, amniotic fluid embolism, HELLP syndrome, retained stillbirth and acute fatty liver of pregnancy are among the complications that underlie obstetric DIC (Erez 2022). At a Nova Scotia tertiary maternity hospital, 49 cases of DIC occurred in 151,678 deliveries between 1980 and 2009; placental abruption was the antecedent cause in 37% and postpartum hemorrhage or hypovolemia in 29% (Rattray 2012). Because normal pregnancy raises fibrinogen, a pregnancy-specific DIC score built on fibrinogen, the PT difference and the platelet count has been developed; at a cut-off of 26 points or more it had 88% sensitivity and 96% specificity (Erez 2022).

In 128 women with postpartum hemorrhage, fibrinogen was the only marker independently associated with progression to severe hemorrhage: at enrolment the risk was 2.63-fold higher for each 1 g/L fall in fibrinogen, a fibrinogen of 2 g/L or less had a positive predictive value of 100%, and a fibrinogen above 4 g/L had a negative predictive value of 79% (Charbit 2007). In a consecutive cohort of 356 women with a 1000 to 1500 mL postpartum hemorrhage, those who went on to need 8 units of blood products had a median fibrinogen of 2.1 g/L (interquartile range 1.8–3.4), against 3.9 g/L (3.2–4.5) in those who did not progress; FIBTEM A5 was an independent predictor of progression to bleeds above 2500 mL (Collins 2014). Both medians sit at or inside the general adult range of 2.0–4.0 g/L.

One shared fibrinogen axis in g/L with three rows. Top row: the general adult normal range of 2.0 to 4.0 g/L from MedlinePlus. Middle row: in Collins 2014, 356 women with a 1000 to 1500 mL postpartum hemorrhage; the median fibrinogen was 2.1 g/L (interquartile range 1.8 to 3.4) in women who went on to need 8 units of blood products and 3.9 g/L (3.2 to 4.5) in those who did not. Bottom row: in Charbit 2007, 128 women with postpartum hemorrhage; a fibrinogen of 2 g/L or less had a positive predictive value of 100% for severe hemorrhage and a value above 4 g/L a negative predictive value of 79%. POSTPARTUM BLEEDING: RISK INSIDE THE NORMAL RANGE Clauss fibrinogen, g/L · two prospective cohorts of women with postpartum hemorrhage, on one shared axis GENERAL ADULT RANGE · MEDLINEPLUS normal 2.0–4.0 COLLINS 2014 · 356 WOMEN, 1000–1500 ML BLEED needed 8 units did not progress 2.1 3.9 CHARBIT 2007 · 128 WOMEN WITH POSTPARTUM HEMORRHAGE ≤ 2: PPV 100% > 4: NPV 79% 1 2 3 4 5 g/L → WHAT THE COHORTS FOUND a median of 2.1 g/L in women whose bleeding progressed sits at the bottom edge of the general adult range risk 2.63-fold higher for each 1 g/L fall at enrolment; fibrinogen was the only marker independently linked to severe hemorrhage (Charbit 2007) pregnancy raises fibrinogen, so the general range is not a pregnancy range middle row: dots are medians, lines interquartile ranges · reference ranges vary between laboratories

Congenital Fibrinogen Disorders

Hyperfibrinolysis

Toh and colleagues note that hyperfibrinolysis is typically characterized by very low fibrinogen levels with very high concentrations of fibrin degradation products (Toh 2016). In major bleeding after trauma, the 2023 European guideline pairs early tranexamic acid, an antifibrinolytic drug, with early fibrinogen administration (Rossaint 2023).

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Fibrinogen as an Acute-Phase Reactant and Inflammatory Marker

Fibrinogen is one of the acute-phase reactants, proteins whose blood level changes during inflammation (Toh 2016). MedlinePlus lists infection and inflammation among the causes of an abnormal fibrinogen result.

Interleukin-6: In 16 patients with COVID-19 acute respiratory distress syndrome admitted to intensive care, the median fibrinogen was 794 mg/dL (interquartile range 583–933), and fibrinogen levels were associated with interleukin-6 values; fibrinogen fell over the following days after thromboprophylaxis was increased (Ranucci 2020).

Conditions linked to fibrinogen in the research:

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Fibrinogen and Cardiovascular Risk

Fibrinogen has been studied both as a participant in thrombosis and as an epidemiological marker of risk for coronary heart disease and stroke.

Mechanistic Role

Fibrin(ogen) provides the scaffolding of a thrombus and has further binding functions, including roles in incorporating platelets into a developing thrombus and in binding leukocytes through the Mac-1 integrin (Mosesson 2005). A 2012 review lists vascular wall disease and stroke among the conditions in which a pro-inflammatory role for fibrinogen has been reported (Davalos 2012).

Epidemiological Evidence

Lifestyle and Treatment Effects on Fibrinogen

What Remains Uncertain

The Fibrinogen Studies Collaboration found moderately strong associations between usual fibrinogen and coronary heart disease, stroke and other mortality, but concluded that assessing any causal relevance of elevated fibrinogen requires additional research (Fibrinogen Studies Collaboration 2005).

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Liver Disease and Fibrinogen

The liver produces fibrinogen (MedlinePlus) and most of the other blood coagulation factors, so a deranged coagulation profile is expected in patients receiving a liver transplant (Bansal 2021).

Cirrhosis and Invasive Procedures

Liver Transplantation

In 50 patients undergoing living-donor liver transplantation, PT, aPTT, platelet count and fibrinogen were measured alongside TEG from before anesthesia through the dissection, anhepatic and reperfusion phases to 24 hours after surgery. Platelet count and fibrinogen correlated significantly with TEG in almost all phases, and the authors describe transfusion decisions as a combination of the clinical assessment of the surgical and anesthesia teams with laboratory and TEG results (Bansal 2021).

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Treatment: Fibrinogen Replacement

Two concentrated sources of fibrinogen are used in bleeding patients: cryoprecipitate and fibrinogen concentrate.

Cryoprecipitate

Fibrinogen Concentrate

Thresholds in Published Guidance

Adjunctive Antifibrinolytic Therapy

Tranexamic acid (TXA) is an antifibrinolytic drug. The 2023 European trauma guideline describes early TXA administration and early fibrinogen administration as both of key importance in bleeding trauma patients (Rossaint 2023).

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Interpretation Points From the Research

The studies above point to several recurring themes in how fibrinogen results are read:

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Key Research Papers

Selected PubMed citations and searches for fibrinogen and coagulation:

  1. Meade TW et al. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet. 1986;2(8506):533–7. — PubMed PMID: 2875280
  2. Fibrinogen Studies Collaboration; Danesh J et al. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA. 2005;294(14):1799–809. — PubMed PMID: 16219884
  3. Levi M, van der Poll T. Disseminated intravascular coagulation: a review for the internist. Intern Emerg Med. 2013;8(1):23–32. — PubMed PMID: 23015284
  4. Toh CH, Hoots WK; SSC on Disseminated Intravascular Coagulation of the ISTH. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost. 2007;5(3):604–6. — PubMed PMID: 17096704
  5. Davalos D, Akassoglou K. Fibrinogen as a key regulator of inflammation in disease. Semin Immunopathol. 2012;34(1):43–62. — PubMed PMID: 22037947
  6. Ranucci M. Fibrinogen supplementation in cardiac surgery: where are we now and where are we going? J Cardiothorac Vasc Anesth. 2013;27(1):1–4. — PubMed PMID: 23182836
  7. Wikkelsø AJ et al. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br J Anaesth. 2015;114(4):623–33. — PubMed PMID: 25586727
  8. Casini A et al. Clinical, laboratory, and molecular aspects of congenital fibrinogen disorders. Semin Thromb Hemost. 2025;51(2):103–110. — PubMed PMID: 39151903
  9. De Pietri L et al. Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: a randomized, controlled trial. Hepatology. 2016;63(2):566–73. — PubMed PMID: 26340411
  10. Ranucci M et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020;18(7):1747–1751. — PubMed PMID: 32302448
  11. Collins PW et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood. 2014;124(11):1727–36. — PubMed PMID: 25024304
  12. Erez O et al. DIC in pregnancy — pathophysiology, clinical characteristics, diagnostic scores, and treatments. J Blood Med. 2022;13:21–44. — PubMed PMID: 35023983
  13. Charbit B et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost. 2007;5(2):266–73. — PubMed PMID: 17087729
  14. Toh CH, Alhamdi Y, Abrams ST. Current pathological and laboratory considerations in the diagnosis of disseminated intravascular coagulation. Ann Lab Med. 2016;36(6):505–12. — PubMed PMID: 27578502
  15. Taylor FB Jr et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86(5):1327–30. — PubMed PMID: 11816725
  16. Mackie I et al. International council for standardisation in haematology recommendations on fibrinogen assays, thrombin clotting time and related tests in the investigation of bleeding disorders. Int J Lab Hematol. 2024;46(1):20–32. — PubMed PMID: 37984807
  17. Undas A. Laboratory testing for fibrinogen disorders: from routine investigations to research studies. Semin Thromb Hemost. 2025;51(6):651–659. — PubMed PMID: 38889802
  18. Kanda GS et al. Pitfalls in the assessment of disseminated intravascular coagulation in patients on dabigatran. Pathology. 2021;53(5):623–627. — PubMed PMID: 33526243
  19. Mosesson MW. Fibrinogen and fibrin structure and functions. J Thromb Haemost. 2005;3(8):1894–904. — PubMed PMID: 16102057
  20. Rattray DD et al. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. 2012;34(4):341–347. — PubMed PMID: 22472333
  21. Szecsi PB et al. Haemostatic reference intervals in pregnancy. Thromb Haemost. 2010;103:718–27. — PubMed PMID: 20174768
  22. Hansen AT et al. Changes in fibrin D-dimer, fibrinogen, and protein S during pregnancy. Scand J Clin Lab Invest. 2011;71(2):173–6. — PubMed PMID: 21190511
  23. Meade TW, Imeson J, Stirling Y. Effects of changes in smoking and other characteristics on clotting factors and the risk of ischaemic heart disease. Lancet. 1987;2:986–8. — PubMed PMID: 2889958
  24. Hammett CJ et al. Effects of exercise training on 5 inflammatory markers associated with cardiovascular risk. Am Heart J. 2006;151:367.e7–367.e16. — PubMed PMID: 16442901
  25. Sahebkar A et al. Head-to-head comparison of statins versus fibrates in reducing plasma fibrinogen concentrations: a systematic review and meta-analysis. Pharmacol Res. 2016;103:236–52. — PubMed PMID: 26657419
  26. Hartweg J et al. Meta-analysis of the effects of n-3 polyunsaturated fatty acids on haematological and thrombogenic factors in type 2 diabetes. Diabetologia. 2007;50(2):250–8. — PubMed PMID: 17119918
  27. Bansal S et al. An observational study of hemostatic profile during different stages of liver transplant surgery using laboratory-based tests and thromboelastography. Anesth Essays Res. 2021;15(2):194–201. — PubMed PMID: 35281353
  28. Nascimento B et al. Cryoprecipitate transfusion in bleeding patients. CJEM. 2020;22(S2):S4–S11. — PubMed PMID: 33084562
  29. Rossaint R et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. — PubMed PMID: 36859355
  30. Wikkelsø A et al. Fibrinogen concentrate in bleeding patients. Cochrane Database Syst Rev. 2013;(8):CD008864. — PubMed PMID: 23986527
  31. Ranucci M et al. Randomized, double-blinded, placebo-controlled trial of fibrinogen concentrate supplementation after complex cardiac surgery. J Am Heart Assoc. 2015;4(6):e002066. — PubMed PMID: 26037084

Reference range source: MedlinePlus Medical Encyclopedia, Fibrinogen blood test (review date 2/3/2025) — medlineplus.gov/ency/article/003650.htm

Fibrinogen coagulation clinical laboratory — PubMed search

Plasma fibrinogen DIC disseminated intravascular coagulation — PubMed search

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Connections

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