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Fibrinogen concentrate for bleeding--a systematic review.

J Lunde1, J Stensballe, A Wikkelsø

  • 1Juliane Marie Centre - Department of Anesthesia, 4013 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Acta Anaesthesiologica Scandinavica
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Fibrinogen concentrate may reduce bleeding and transfusion needs in patients with hypofibrinogenaemia. However, evidence from randomized controlled trials is limited and shows high risk of bias, warranting further research.

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Area of Science:

  • Medical research
  • Hematology
  • Critical care medicine

Background:

  • Fibrinogen concentrate is increasingly considered for treatment protocols.
  • Hypofibrinogenaemia treatment aims to reduce bleeding, transfusion needs, morbidity, and mortality.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) and non-randomized studies on fibrinogen concentrate use in bleeding patients.
  • To assess the efficacy of fibrinogen concentrate in reducing bleeding and transfusion requirements.

Main Methods:

  • A systematic literature search was conducted up to November 2013.
  • Included studies comprised 7 RCTs and 23 non-randomized studies, totaling 3480 patients.
  • RCTs were assessed for risk of bias.

Main Results:

  • Two RCTs showed significant reduction in bleeding, and five showed reduced transfusion requirements.
  • Non-randomized studies suggested reductions in transfusion needs, mortality, and bleeding, but had methodological shortcomings.
  • RCTs indicated significant reductions in bleeding and transfusions but lacked mortality data and had high risk of bias.

Conclusions:

  • Weak evidence from RCTs supports fibrinogen concentrate use, particularly in cardiac surgery.
  • General use across all settings is supported only by lower-quality non-randomized studies.
  • More high-quality RCTs are needed to establish the routine role of fibrinogen concentrate in managing bleeding and coagulopathic patients.