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Use of lyophilized fibrinogen concentrate in cardiac surgery: a systematic review
Thiago Augusto Azevedo Maranhão Cardoso1, Caetano Nigro Neto1, Carlos Gustavo Santos Silva1
1Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil.
Insights
Fibrinogen concentrate may reduce bleeding and blood product use in cardiac surgery. However, more randomized trials are needed to confirm its benefits for perioperative bleeding management.
Area of Science:
- Anesthesiology
- Cardiovascular Surgery
- Hematology
Background:
- Fibrinogen concentrate use is increasing in cardiac anesthesia to reduce bleeding and allogeneic blood transfusions.
- Viral inactivation of fibrinogen products minimizes transfusion-related contamination risks.
- Cardiopulmonary bypass often exacerbates bleeding and the need for blood components.
Purpose of the Study:
- To review the literature for randomized controlled trials on fibrinogen concentrate's benefits in cardiac surgery.
- To assess the efficacy of fibrinogen concentrate in managing perioperative bleeding.
Main Methods:
- Literature search conducted in BioMed Central, PubMed, Embase, and Cochrane Central Register of Clinical Trials.
- Included randomized controlled trials from the last 10 years comparing fibrinogen concentrate to standard treatment or placebo.
- Two investigators performed the search and selection process.
Main Results:
- Only four randomized controlled trials met the selection criteria.
- A total of 79 patients received fibrinogen concentrate therapy in the analyzed trials.
- Limited data exists from randomized trials specifically in cardiac surgery.
Conclusions:
- Few randomized controlled trials have confirmed the benefits of lyophilized fibrinogen for reducing bleeding in cardiac surgery over the past decade.
- Fibrinogen concentrate can be a valuable option for managing perioperative bleeding and reducing blood product consumption when indicated.
- Treatment should follow an algorithm guided by point-of-care testing.
Introduction:
Use of fibrinogen concentrate among cardiac anesthetists is growing especially for the benefits related to the reduction in the administration of bleeding and allogeneic blood components, which are exacerbated by cardiopulmonary bypass. Moreover, these products underwent complete viral inactivation, reducing the risks of contamination associated with transfusion. The purpose of this research was to review the literature looking for randomized controlled trials regarding fibrinogen concentrate and its benefits in cardiac surgery.
Method:
The papers used in this review were searched in BioMed Central, PubMed, Embase, and the Cochrane Central Register of Clinical Trial by two investigators. The full search strategy was performed to identify all randomized controlled trials in the last 10 years, comparing the use of fibrinogen in the adult treatment of perioperative bleeding to standard treatment or placebo.
Results:
Only four articles matching the selection criteria for final analysis were identified and only 79 patients received therapy with fibrinogen concentrate in randomized trials performed in cardiac surgery.
Conclusions:
During the last 10 years, few randomized controlled trials were performed to confirm the real benefit of using lyophilized fibrinogen to reduce bleeding in cardiac surgery. However, when indicated, it may be a good option in order to reduce the consumption of blood products in the treatment of perioperative bleeding, following an algorithm based on point-of-care testing.
