Should You Take Fibrolytics? – Center for Health Science

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Although fibrinogen is not typically viewed as a direct cause of disease, abundant research supports the correlation of elevated Fibrinogen/Albumin Ratio (FAR) with:

Strokes
Heart Attacks
Neurodegenerative Disorders
Cancer
Kidney Disorders
Senile Purpura, Psoriasis and Other Dermatological Conditions

A substantial amount of scientific research supports fibrolytics as a possible preventative and treatment for cardiovascular disease (including heart attacks and strokes) and several other health conditions, yet its testing and treatment is seldom undertaken in western medicine.

I always recommend we take responsibility for our own health. Read further and you decide!

Fibrinogen is a plasma protein involved in blood clotting and inflammation. Its levels are partially determined by genetic variations in the FGA, FGB, and FGG genes (which encode the three fibrinogen chains). Fibrinogen is converted to fibrin when tissue is damaged. Fibrin forms the mesh during the formation of blood clot. This mesh can be broken down by thrombolytics, such as tissue-type plasminogen activator (tPA), used to dissolve clots and treat ischemic strokes and heart attacks.

Studies suggest that 30-50% of fibrinogen level variability is due to genetics. Because of this, it is reasonable to look at family and personal history to determine if high fibrinogen is a risk factor for you, and to guide treatment.

Fibrinogen concentrations vary widely among populations and increase with age. Levels are consistently higher in women than men and rise after menopause. Smoking is the most important lifestyle correlate of fibrinogen. People with diabetes and hypertension have elevated fibrinogen levels, as do sedentary and obese individuals. Alcohol intake and estrogen replacement therapy are associated with lower fibrinogen levels. Most other CVD risk factors are correlated positively with fibrinogen.

Researchers and clinicians assess risk based on the ratio of circulating fibrinogen to albumin, another blood protein. The Fibrinogen/Albumin Ratio (FAR) is used to assess risk, prognosis, and disease severity and to guide treatment.

FAR = Fibrinogen (g/L) / Albumin (g/L)

FAR Range	Risk	Significance
<0.08	Low	Normal, minimal inflammation
0.08 – 0.12	Mild	Slight inflammation, mild risk for disease
0.12 – 0.20	Moderate	Increased inflammatory response, potential chronic disease risk
>0.20	High	Significant inflammation, associated with worse prognosis

Should FAR testing should be considered as part of an annual check-up?

It is well established that FAR is a sensitive and useful marker of inflammation. The question remains, does a genetically driven elevated fibrinogen concentration CAUSE damage, or just reflect it? Current science has no answer for this. Inflammation is a common and pervasive aspect of the human condition.

Whether elevated fibrinogen is caused or inherited, logic suggests that testing is appropriate for everyone to assess risk and to guide treatment. It would seem appropriate to order the inexpensive fibrinogen test as part of an annual checkup, along with a CMP (which includes albumin). Testing more often may be appropriate for those who have been diagnosed with cancer, cardiovascular disease, chronic inflammatory and autoimmune diseases, or liver disease.

The Tests:

Fibrinogen Activity CPT: 85384
Albumin as part of a Comprehensive Metabolic Panel CPT: 80053

Note: Your health insurance will likely deny payment for the fibrinogen test if it is ordered as part of a routine wellness check without symptoms or medical necessity. (see coding conditions at the end of this paper) If this happens you will be billed full list price for this test by the lab.

The Fibrinogen Activity and CMP Tests can be ordered from us at a discounted price of $58.85 (total). (Note: New York, New Jersey and Rhode Island to not permit independent testing.) Click to order:

Fibrinogen/Albumin Test Package

Treatment Options

Pharmaceuticals have not been developed to safely dissolve arterial plaque or blood clots. Thrombolytics such as tPA actively break down clots but are very aggressive and typically are used only in emergencies, such as stroke or massive pulmonary embolism. Anticoagulants (“blood thinners”) such as warfarin, Eliquis and Pradaxa inhibit clotting factors but do not dissolve existing plaques or clots. Antiplatelets (aspirin, Plavix) block platelet activation but do not dissolve existing plaques or clots.

Nature, however, does provide! Natural fibrolytic enzyme supplements are available over the counter. These are not as potent as pharmaceutical fibrolytics but do reduce fibrinogen. They are not “approved” by the FDA as they are classified as food.

Nattokinase: Derived from Natto (fermented soybeans), breaks down fibrin, potentially reducing the risk of excessive clot formation. It has moderate platelet aggregation effects, check for interactions.

Lumbrokinase: Extracted from earthworms. Similar to nattokinase, it has fibrinolytic and anti-coagulant effects. It has long been used in Traditional Chinese Medicine for improving blood circulation. It has strong platelet aggregation effects, check for interactions.

Serrapeptase: An enzyme derived from silkworms. Thought to help break down proteins involved in inflammation and clot formation. It has mild platelet aggregation effects.

Bromelain: Found in pineapple, this enzyme may have mild fibrinolytic and anti-inflammatory properties. It has mild platelet aggregation effects.

Abundant research can be found for all four of these enzymes. OTC formulas with these enzymes are available in health food stores and on Amazon: Useful amounts are found in Spliferkou Liposomal Lumbrokinase Nattokinase Serrapeptase Complex, for example. They should not be used concurrently with anticoagulant or anti-platelet drugs.

Fibrinogen and Cardiovascular Disease, Heart Attacks and Strokes

1. Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases: “Nattokinase (NK), the most active ingredient of natto, possesses a variety of favourable cardiovascular effects and the consumption of Natto has been linked to a reduction in CVD mortality. Recent research has demonstrated that NK has potent fibrinolytic activity, antihypertensive, anti-atherosclerotic, and lipid-lowering, anti platelet, and neuroprotective effects. (It) is therefore an ideal drug candidate for the prevention and treatment of CVD. Nattokinase is a promising alternative in the management of CVD.”
  Biomarker Insights. https://doi.org/10.1177/1177271918785130
2. Lipid-lowering, antihypertensive, and antithrombotic effects of nattokinase combined with red yeast rice in patients with stable coronary artery disease: a randomized, double-blinded, placebo-controlled trial: “Nattokinase (NK) and red yeast rice (RYR) are both indicated for their potential in cardiovascular disease prevention and management… the combined NK and RYR supplementation is safe and more effective than separately in improving cardiometabolic markers among CAD patients with multiple heart medications use.”
  Frontiers in Nutrition. https://doi.org/10.3389/fnut.2024.1380727
3. Comparative Cardioprotective Effectiveness: NOACs vs. Nattokinase—Bridging Basic Research to Clinical Findings: “This enzyme showed not only fibrinolytic activity due to its ability to degrade fibrin, but also affinity as a substrate for plasmin. Recent studies have shown that NK has additional cardioprotective effects, such as antihypertensive and anti-atherosclerotic effects…NK could become an important agent that can be used as monotherapy or as a supplement in various CVDs.”
  Biomolecules. https://doi.org/10.3390/biom14080956
4. Nattokinase attenuates endothelial inflammation through the activation of SRF and THBS1: “Our results revealed that NK upregulates the SRF and THBS1 genes and subsequently leads to increase autophagy and decrease necroptosis and NLRP3 inflammasome formation to reduce vascular inflammation (Fig. 8). Our findings provide evidence that promising outcomes in the reduction of vascular inflammation and possible atherosclerosis progression can be achieved safely by using NK as nutraceuticals or adjuvant therapy for ASCVD.
  International Journal of Biological Macromolecules. https://doi.org/10.1016/j.ijbiomac.2024.131779
5. Nattokinase as a potential therapeutic agent for preventing blood-brain barrier dysfunction in neurodegenerative disorders: “Pathological destruction of BBB is associated with major neurodegenerative disorders. “Nattokinase, a food content widely used in Japan, is known to have neuroprotective effects. NK supplementation ameliorates BBB dysfunction, reduce brain inflammation, and improve cognitive ability. NK may serve as an effective opponent for BBB breakdown.”
  Brain Research. https://doi.org/10.1016/j.brainres.2024.149352
6. Nattokinase Uses and Benefits: “Nattokinase is a highly valuable, safe and easy-to-use nutraceutical with a wide area of medical applications for the treatment of thrombotic, neurological and dyslipidemia conditions, arterial hypertension, diabetes mellitus, atherosclerosis, hemorrhoids, endometriosis, uterine fibroids, muscle spasms, infertility in reproductive medicine and obstetrics.”
  Trakia Journal of Sciences. http://tru.uni-sz.bg/tsj/Volume%2021,%202023,%20Number%204,%20Series%20Biomedical%20Sciences/7-M.Hristova.pdf
7. Elevated Plasma Fibrinogen : Cause or Consequence of Cardiovascular Disease? “An association between increased plasma fibrinogen and an increased risk for myocardial infarction (MI) is well established, but the nature of this association is subject to debate... With increasing plasma fibrinogen level, the risk for MI increased gradually; a rise in fibrinogen of 1 g/L was associated with a 45% increased risk (odds ratio adjusted for age, sex, and smoking, 1.45; 95% CI, 1.12 to 1.88)”
  Arteriosclerosis, Thrombosis, and Vascular Biology. https://doi.org/10.1161/01.atv.18.4.621
8. Epidemiology of Fibrinogen: “Elevated fibrinogen is a well-established risk factor for ischemic stroke, heart attacks. Multiple studies have confirmed that elevated fibrinogen levels are strongly associated with an increased risk of stroke and a strong predictor of coronary heart disease and heart attack risk. High fibrinogen contributes to hypercoagulability and blood clots, vascular inflammation, and atherosclerosis and plaque formation. “Lowering fibrinogen levels may help reduce the risk of heart attacks and strokes.”
  Conclusion of Scholar GPT 4.0 (accessed 1/30/25)
9. Update on fibrinogen as a cardiovascular risk factor: “Mounting data support a causal connection between high-normal fibrinogen levels and atherosclerotic cardiovascular disease. This offers the possibility to better identify high-risk candidates and also to protect them by reducing blood fibrinogen concentration or blocking its action. Each standard deviation increase in fibrinogen is associated with a 30% increment of coronary heart disease in men and a 40% increase in women. Fibrinogen should be added to the list of major cardiovascular risk factors.”
  Annals of Epidemiology. https://doi.org/10.1016/1047-2797(92)90095-8
10. Elevated fibrinogen levels and subsequent subclinical atherosclerosis: The CARDIA Study: “An elevated fibrinogen concentration in persons aged 25–37 is independently associated with subclinical cardiovascular disease in the subsequent decade.” Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2008.05.039
11. Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature: “All prospective studies showed that fibrinogen was associated with subsequent myocardial infarction or stroke. A total of 92,147 person-years was covered by these investigations. Odds ratios varied between 1.8 (95% CI, 1.2 to 2.5) in the Framingham and 4.1 (CI, 2.3 to 6.9) in the GRIPS study, with a summary odds ratio of 2.3 (CI, 1.9 to 2.8). Associations existed between fibrinogen and other cardiovascular risk factors, but after multivariate analysis, only the association between fibrinogen and cardiovascular events remained.”
  Ann Intern Med. https://doi.org/10.7326/0003-4819-118-12-199306150-00008
12. Association between Fibrinogen-to-Albumin Ratio and Adverse Stroke Outcomes among Patients with Acute Ischemic Stroke: “Fibrinogen-to-albumin ratio (FAR) is implicated in prothrombotic states and is associated with an increased risk of acute ischemic stroke (AIS). High FAR (>11.44) increased the risk of short- and long-term poor functional outcomes, including disability and all-cause death among patients with AIS.”
  Cerebrovasc Dis. https://doi.org/10.1159/000535303
13. High Fibrinogen to Albumin Ratio: A Novel Marker for Risk of Stroke-Associated Pneumonia? “High FAR is an independent potential risk factor of Stroke-associated pneumonia, which can help clinicians identify high-risk patients with SAP after acute ischemic stroke.”
  Front Neurol. https://doi.org/10.3389/fneur.2021.747118
14. Association Between Admission Blood Fibrinogen-To-Albumin Ratio and Clinical Outcomes After Acute Lacunar Stroke: “FAR =0.077 on admission might be an independent predictor of disability and death/disability at 3 months after lacunar stroke.”
  Biomarkers in Medicine. https://doi.org/10.2217/bmm-2019-0537
15. Prognostic Influence of Increased C-Reactive Protein and Fibrinogen Levels in Ischemic Stroke: “The probabilities of death or new vascular event were 21.1%, 27.9%, and 51.7% (P=0.0172, ?2 for trend), respectively, in patients stratified by tertiles of fibrinogen (<3.78, 3.78 to 6.17, and >6.17 g/L).”
  Stroke. https://doi.org/10.1161/01.str.32.1.133
16. Level of fibrinogen and risk of fatal and non-fatal stroke. EUROSTROKE: a collaborative study among research centres in Europe: “This analysis of the EUROSTROKE project indicates that fibrinogen is a powerful predictor of stroke. The risk of stroke gradually increased with increasing fibrinogen levels: the odds ratios per quartile increase were 1.08 (95% CI 0.63 to 1.84), 1.91 (1.12 to 3.26) and 2.78 (1.64 to 4.72), respectively. This association was similar for ischaemic (n=138) and haemorrhagic stroke (n=25). Associations between fibrinogen and stroke were similar across strata of smoking, diabetes mellitus, previous myocardial infarction, and HDL cholesterol.”
  J Epidemiol Community Health. https://doi.org/10.1136/jech.56.suppl_1.i14
17. The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI: “Previous studies show that serum fibrinogen levels are established risk factors for coronary artery disease. In the present study, we showed that FAR is significantly related to SS in predicting the severity of CAD in patients with ST-elevation myocardial infarction.”
  The American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2016.03.003
18. Association between fibrinogen-to-albumin ratio and the presence and severity of coronary artery disease in patients with acute coronary syndrome: “The levels of FAR are independently associated with the presence and the severity of coronary artery disease in patients with ACS. Furthermore, FAR, as a more convenient and rapid biological indicator, may provide a new idea for predicting the presence and severity of acute coronary syndrome.”
  BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-021-02400-z
19. Association between fibrinogen-to-albumin ratio and prognosis of patients with heart failure: Fibrinogen-to-albumin ratio is an independent risk prognostic factor for 90-day, 1-year all-cause mortality and LOS among HF patients.
  The European Journal of Clinical Investigation. https://doi.org/10.1111/eci.14049
  
  Fibrinogen and Neurodegenerative Disorders
  
  Fibrinogen, a blood-clotting protein, has been implicated in multiple neurodegenerative diseases, including Alzheimer’s disease (AD), Parkinson’s disease (PD), multiple sclerosis (MS), and other dementias. Recent research suggests that fibrinogen may contribute to neuroinflammation, oxidative stress, and abnormal protein aggregation in these conditions.
20. Fibrinogen and/or Fibrin as a Cause of Neuroinflammation: “Elevated level of fibrinogen accompanies inflammatory diseases such as stroke, hypertension, diabetes and traumatic brain injury (TBI) . Blood level of fibrinogen increases during inflammation in general. fibrinogen is considered not only a marker of inflammation but also a cause of inflammatory responses. Gradual extravascular deposition of fibrinogen in the brain accelerates neurovascular damage and promotes neuroinflammation. It has been shown that fibrinogen is associated with an increased risk of dementia and AD. Derivative of ,fibrinogen, fibrin has been found postmortem in the brains of patients with TBI, Alzheimer’s Disease (AD), and multiple sclerosis (MS). Elevated blood levels of fibrinogen are found to be associated with increased risk of AD, cognitive decline, and dementia. Furthermore, formations of plaques containing fibrinogen/fibrin were found in inflammatory neurodegenerative diseases associated with memory reduction such as AD, MS, and TBI. Strong association of Fg/fibrin with amyloid beta (Aß) peptide was linked to severity of AD.”
  The International Journal of Neurology and Brain Disorders. https://pubmed.ncbi.nlm.nih.gov/34327331/
21. Fibrinogen, a possible key player in Alzheimer’s disease: “AD patients have an abnormal cerebral vasculature and brain hypoperfusion, and a large body of research, including some from our lab, implicates cerebrovascular dysfunction as a contributing factor to AD. Reducing fibrinogen, a circulating protein critical in hemostasis, provides a significant decrease in the neurovascular damage, blood–brain barrier permeability and neuroinflammation present in AD. These studies implicate fibrinogen as a possible contributor to AD.”
  Journal of Thrombosis and Haemostasis. https://doi.org/10.1111/j.1538-7836.2009.03376.xdoi.org/10.1111/j.1538-7836.2009.03376.x
22. Fibrin deposited in the Alzheimer’s disease brain promotes neuronal degeneration: “Substantial evidence shows increased thrombosis as well as a critical role for fibrin(ogen) in AD. This molecule has been implicated in neuroinflammation, neurovascular damage, blood-brain barrier permeability, vascular amyloid deposition, and memory deficits that are observed in AD. Here, we present evidence demonstrating that fibrin deposition increases in the AD brain and correlates with the degree of pathology. Moreover, we show that fibrin(ogen) is present in areas of dystrophic neurites and that a modest decrease in fibrinogen levels improves neuronal health and ameliorates amyloid pathology in the subiculum of AD mice..”
  Neurobiology of Aging. PMID: 25475538
23. Pathogenic Role of Fibrinogen in the Neuropathology of Multiple Sclerosis: A Tale of Sorrows and Fears. “Fibrinogen is associated with MS neuropathology through interruption of BBB integrity, induction of neuroinflammation, and demyelination with inhibition of the remyelination process by suppressing oligodendrocytes..”
  Neurochemical Research. org/10.1007/s11064-023-03981-1
24. Fibrinogen in neurological diseases: mechanisms, imaging and therapeutics: “Fibrinogen is deposited in the brain in a wide range of neurological diseases and traumatic injuries with blood–brain barrier (BBB) disruption. Recent research has uncovered pleiotropic roles for fibrinogen in the activation of CNS inflammation, induction of scar formation in the brain, promotion of cognitive decline and inhibition of repair. The cellular and molecular mechanisms underlying the actions of fibrinogen are beginning to be elucidated, providing insight into its involvement in neurological diseases, such as multiple sclerosis, Alzheimer disease and traumatic CNS injury.”
  Nature Reviews Neuroscience. doi.org/10.1038/nrn.2018.13
25. Availability of Fibrinogen/Albumin ratio in MS attack: “High Fibrinogen/Albumin ratio in blood has been shown in some inflammatory diseases. High Fibrinogen/Albumin ratio can be a useful indicator in MS attack. Serum fibrinogen and FAR levels in the patients presenting with an attack were significantly higher than the control group. FAR value did not vary with disease duration and EDSS score.”
  Multiple Sclerosis and Related Disorders. doi.org/10.1016/j.msard.2022.103674
26. The potential value of fibrinogen to albumin ratio (FAR) in the assessment of inflammation in spondyloarthritis: “FAR level in spondyloarthritis patients was higher than in osteoarthritis patients and healthy controls. The FAR level was significantly related to erythrocyte sedimentation rate and C-reactive protein. After regression and receiver operating characteristics analysis. The recommended cut-off value of FAR was 9.44 for serious inflammation and 8.34 for mild conditions.”
  BMC Musculoskeletal Disorders. doi.org/10.1186/s12891-022-05797-6
  
  Fibrinogen and Cancer
  
  Research indicates that elevated fibrinogen levels are associated with cancer progression, metastasis, and poor prognosis in various types of cancer. It plays a role in tumor growth, immune evasion, and blood clot formation, making it a potential biomarker and therapeutic target.
27. Fibrinogen-to-Albumin Ratio is Associated with All-Cause Mortality in Cancer Patients: “Higher FAR values significantly correlated with 90- and 365-day all-cause mortality relative to low FAR values (tertile 3 vs tertile 1: HR, 95% CI: 1.65, 1.15–2.39; 1.52, 1.10–2.10). Our findings indicate that FAR may predict the risk of cancer mortality and is an independent prognostic indicator of all-cause mortality in cancer patients.”
  International Journal of General Medicine. doi.org/10.2147/IJGM.S322735
28. Prognostic role of preoperative fibrinogen to albumin ratio in breast cancer: “Elevated serum concentration of fibrinogen and decreased serum concentration of albumin have been reported to be markers of elevated systemic inflammation. We investigate the prognostic influence of preoperative fibrinogen to albumin ratio (FAR) for breast cancer. Preoperative FAR was a strong independent prognostic factor in breast cancer.”
  Journal of Breast Cancer. doi.org/10.4048/jbc.2017.20.3.254
29. Fibrinogen and Endometrial Cancer Progression: “High fibrinogen (≥3.185 g/L), NLR (≥2.521 g/L), and CA125 (≥35 U/mL) levels and low ALB (<4.185 g/L) levels were independently associated with poor progression-free survival (PFS) and poor overall survival (OS) in patients with endometrial cancer. ”
  Journal of Cancer Research. doi.org/10.1038/sj.bjc.6605547
30. Fibrinogen and tumors: “Elevated plasma fibrinogen (Fg) levels consistently correlate with an unfavorable prognosis in various tumor patient cohorts. Within the tumor microenvironment, aberrant deposition and expression of Fg have been consistently observed, interacting with multiple cellular receptors and thereby accentuating its role as a regulator of inflammatory processes. Specifically, Fg serves to stimulate and recruit immune cells and pro-inflammatory cytokines, thereby contributing to the promotion of tumor progression.”Front Oncol. doi: 10.3389/fonc.2024.1393599
31. The association of an elevated plasma fibrinogen level with cancer-specific and overall survival in prostate cancer patients: “In recent studies, an elevated plasma fibrinogen level has been associated with poor prognosis in different types of cancer. Our data show a significant association between an elevated plasma fibrinogen level and poor prostate cancer prognosis.”
  World Journal of Urology. doi.org/10.1007/s00345-014-1459-2
  
  Fibrinogen and Kidney Disorders
  
  Fibrinogen is strongly implicated in various kidney disorders, particularly acute kidney injury (AKI), chronic kidney disease (CKD), and diabetic nephropathy. Elevated fibrinogen levels contribute to inflammation, thrombosis, and fibrosis, worsening kidney function.
32. Pharmacological and genetic depletion of fibrinogen protects from kidney fibrosis: “Fibrinogen (Fg) has been implicated in the pathogenesis of several fibrotic disorders by acting as a profibrotic ligand for a variety of cellular surface receptors and by modulating the provisional fibrin matrix formed after injury. Fibrinogenolysis through Ancrod administration after FA reduced interstitial fibrosis more than threefold compared with vehicle-treated control mice. This study offers increased understanding of Fg expression and molecular interactions with TGF-β1 in the progression to kidney fibrosis and, importantly, indicates that fibrinogenolytics like Ancrod present a treatment opportunity for a yet intractable disease. ”
  American Journal of Physiology: doi.org/10.1152/ajprenal.00189.2014
33. Disorders of hemostasis associated with chronic kidney disease: “Patients with CKD have increased fibrinogen levels, which are linked to higher cardiovascular risks. Fibrinogen contributes to inflammation and coagulation disorders in CKD patients.”
  Seminars in Thrombosis and Hemostasis. doi.org/10.1055/s-0030-1248722
  
  Fibrinogen and Dermatological Conditions
  
  Elevated fibrinogen levels are linked to chronic urticaria, angioedema, psoriasis, scleroderma, and wound healing disorders. It plays a dual role in wound healing—helping with clotting but also interfering with keratinocyte adhesion, potentially leading to chronic wounds.
34. Association of IL-17 with D-dimer and Fibrinogen, as a Risk Factor for Thromboembolism in Psoriasis Patients: “Psoriasis patients had significantly higher levels of D-dimer, Fibrinogen, and IL?17 levels (p<0,01) more than the controlling?group. D-dimer and Fibrinogen along with higher IL-17 levels have been identified as predictive factors for greater danger of cardiovascular illnesses in individuals having moderately to severely severe psoriasis.”
  Magazine of Al-Kufa University for Biology https://openurl.ebsco.com/EPDB%3Agcd%3A13%3A2591741/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A181791609&crl=c&link_origin=scholar.google.com
35. Fibrinogen is Associated with Clinical Adverse Events in Patients with Psoriasis and Coronary Artery Disease: “Elevated fibrinogen levels were associated with adverse clinical events in patients with psoriasis and CAD, especially among patients aged < 60 years, those with diabetes, and those not admitted for acute cardiovascular syndrome. After a median follow-up of 35.5 months, the incidence of major adverse cardiovascular events (MACEs) was higher in patients in high fibrinogen group compared with patients in low fibrinogen group (31.4% vs 16.4%, p = 0.013)..”
  Journal of Immunology Research doi.org/10.2147/JIR.S427992
36. Psoriatic disease is associated with systemic inflammation, endothelial activation, and altered haemostatic function: “ Hypercoagulability is a potential underlying mechanism that may contribute to the increased risk of major cardiovascular events in psoriatic individuals. Scanning electron microscopy revealed that fibrin clots were denser in psoriatic individuals, compared to healthy controls, with an increased fibrin fibre diameter associated with psoriatic disease.”
  Scientific Reports doi.org/10.1038/s41598-021-90684-8
37. Fibrinogen-Like Protein 1 as a Novel Biomarker of Psoriasis Severity: “ FGL1 was inversely correlated with high-density lipoprotein cholesterol and IL-17 in the psoriatic state serum. FGL1 may be a promising biomarker for diagnosing and staging psoriasis. It may also be involved in its progression and comorbid abnormal lipid metabolism.”
  Journal of Inflammation Research. doi/pdf/10.2147/JIR.S378953
38. Should Psoriasis Patients Monitor Fibrinogen? “Yes. Elevated fibrinogen levels in psoriasis patients may indicate higher inflammation, cardiovascular risk, and disease severity. Testing fibrinogen levels in psoriasis patients with cardiovascular risk factors may be beneficial for preventing thrombotic complications.” (Scholar GPT 4.0 accessed 1/21/25)
39. Role of plasma fibrinogen in assessing disease activity of patients with gout: “The aim of this study is to reveal the predictive value of plasma fibrinogen, D-dimer in the disease activity of gout patients. Plasma fibrinogen and D-dimer in gout patients (3.66 (2.88, 5.20), 0.29 (0.22, 0.80)) were increased as compared with the control group (2.88 (2.51, 3.24), 0.22 (0.22, 0.32), both P < 0.001). Fibrinogen and D-dimer in active group (3.91 (3.00, 5.53), 0.34 (0.22, 0.86)) were higher than those in remission group (2.88 (2.34, 3.22), 0.22 (0.22, 0.26), both P < 0.001)). Fibrinogen was increased in active gout group. Fibrinogen can serve as a reliable inflammatory marker for monitoring inflammatory response and disease activity in gout patients.
  Clin Chim Acta: https://doi.org/10.1016/j.cca.2020.08.012

Coding for Medicare Reinbursement for Fibrinogen Activity Test CPT: 85384

Medicare Part B provides coverage for the Fibrinogen Activity Test (CPT code 85384) when it is deemed medically necessary. This determination is typically based on the presence of specific clinical indications, such as:

- Evaluation of unexplained bleeding or thrombotic disorders.
- Assessment of liver function abnormalities.
- Investigation of disseminated intravascular coagulation (DIC).
- Monitoring of fibrinogen levels in patients with known fibrinogen deficiencies or dysfibrinogenemia.

It’s important to note that Medicare does not cover fibrinogen testing when used solely for cardiovascular disease risk assessment in asymptomatic individuals. According to Aetna’s Clinical Policy Bulletin, “fibrinogen may be measured as part of refined risk assessment… Thus this test does not meet Medicare’s reasonable and necessary criteria for coverage.”
aetna.com accessed 2/2/25

To ensure coverage, the test must be ordered by a healthcare provider who deems it necessary based on the patient’s medical condition. The provider should document the specific clinical indications and ensure that the appropriate diagnosis codes are included when submitting the claim to Medicare.

Given that coverage policies can vary and may be updated over time, it’s advisable to consult the latest Medicare guidelines or contact your Medicare Administrative Contractor (MAC) for the most current information regarding coverage criteria for the Fibrinogen Activity Test.

Note: The following documented information is provided as information only and is not intended as medical advice. Any information given is intended as a sharing of knowledge and information from scientific world literature, referenced to accepted, peer-reviewed scientific journals. These statements have not been evaluated by the Food and Drug Administration. Information provided by CHS is not intended to diagnose or treat any disease or replace a one-on-one relationship with a qualified health care professional . You are encouraged to make your own health care decisions based upon your own research of the subject and in partnership with a qualified health care professional.