Efficacy and Safety of Fibrinogen Concentrate in Surgical Patients: A Meta-Analysis of Randomized Controlled Trials

Fominskiy, Evgeny; Непомнящих, В. А.; Lomivorotov, Vladimir V.; Monaco, Fabrizio; Vitiello, Chiara; Zangrillo, Alberto; Landoni, Giovanni

doi:10.1053/j.jvca.2016.04.015

Cited by 37 publications

(14 citation statements)

References 39 publications

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“…It has a good safety profile with low thrombogenic potential. 6 It is also effective in the perioperative management of patients with congenital fibrinogen disorders. 7 The way in which fibrinogen concentrate is prepared also carries a lower risk of immunological side effects and reduced risk of viral transmission.…”

Section: Discussionmentioning

confidence: 99%

<p>Impact of Incorporation of Fibrinogen Concentrate in Blood Transfusion Management During Liver Transplantation: An Early Local (Single Centre) Experience</p>

Ho¹,

Lim²,

Lai³

2020

IJCTM

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Background: Orthotopic liver transplantation surgery is associated with major bleeding, often requiring transfusions of blood products such as red cell concentrates, plasma, platelets and cryoprecipitate. Fibrinogen concentrate was made available in our institution in January 2017 and is increasingly being used as an alternative strategy to reduce transfusion requirements. Limited literature exists to show the effectiveness of fibrinogen concentrate on blood loss during liver transplantation surgery, as well as its impact on blood transfusion requirements. Methods: This is a retrospective, observational study conducted at a single, large, tertiary centre in Singapore to evaluate the impact of incorporating fibrinogen concentrate on blood transfusion requirements during orthotopic liver transplantation surgery from January 2014 to December 2018. Results: A total of 54 patients who underwent liver transplantation during this period were studied. Forty patients did not receive fibrinogen concentrate during the surgery while 14 patients did. No statistically significant difference was detected in the baseline preoperative characteristics of both groups of patients in terms of MELD or preoperative INR. The mean INR in patients who did not receive fibrinogen concentrate was 1.77 while that in patients who received fibrinogen concentrate was 2.21. While not statistically significant, clinically this may be of significance. There was a significant difference in the starting haemoglobin level of the patients, with a lower starting haemoglobin level in patients who received fibrinogen concentrate (p=0.039). No significant difference was noted in the amount of blood loss, amount of red cell transfusions and amount of fresh plasma transfused. Of note, patients who received fibrinogen concentrate had a significantly less amount of cryoprecipitate transfused compared to those who did not (p=0.002). Conclusion: The intraoperative use of fibrinogen concentrate did not seem to have any statistically significant difference in the amount of blood loss during surgery. However, the amount of cryoprecipitate used was significantly reduced with the introduction of fibrinogen concentrate.

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Section: Discussionmentioning

confidence: 99%

<p>Impact of Incorporation of Fibrinogen Concentrate in Blood Transfusion Management During Liver Transplantation: An Early Local (Single Centre) Experience</p>

Ho¹,

Lim²,

Lai³

2020

IJCTM

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“…Multicomponent transfusions with cryoprecipitate were infrequent in most patient populations, being most commonly administered in massively transfused patients. However, it should be noted that the use of cryoprecipitate may have been underestimated in studies if fibrinogen concentrate was administered instead of cryoprecipitate (Forminsky et al, ; Winearls et al, ). Based on limited data from two studies, multicomponent transfusion prevalence estimates did not vary greatly over time within patient populations; however, more data are needed prior to drawing conclusions regarding trends over time.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of multicomponent blood transfusion: a systematic review

Perelman

Khair

Dermer

et al. 2019

Transfusion Medicine

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We performed a systematic review to describe the prevalence of multicomponent blood transfusion and, as a secondary objective, to determine patient characteristics and outcomes associated with multicomponent transfusion. There is a lack of literature on the epidemiology of multicomponent transfusion as most studies concentrate on a single blood product and its utilisation. Patient care and blood management can be optimised by better understanding the patients who receive multicomponent transfusions. The databases Medline, EMBASE and the Cochrane Library of Systematic Reviews were searched. Observational cohort and cross-sectional studies of hospital patients reporting on multicomponent transfusion prevalence or on patient characteristics and outcomes associated with multicomponent transfusion were included. A descriptive synthesis of studies was performed. A total of 37 eligible studies were included. It was found that multicomponent transfusion prevalence varied greatly by patient population and by the combination of blood products given in the multicomponent transfusion. Multicomponent-transfused patients included burn, cardiac surgery, liver surgery and transplant, cancer, infectious diseases, trauma and intensive care unit patients. Five studies found associations between multicomponent transfusion and adverse health outcomes; however, these findings are likely confounded by indication. The overall quality of evidence was low given a fair-to-poor individual study quality, inconsistent multicomponent transfusion prevalence estimates and confounding by indication. Further research is needed to better understand the epidemiology of multicomponent transfusion, including studies on multicomponent transfusion in haematological cancer patients and studies looking for patient characteristics that can better predict multicomponent transfusion need.

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“…A meta-analysis of 14 randomized clinical trials involving 1,035 adult and pediatric surgical patients demonstrated that fibrinogen concentrate therapy was associated with reduced bleeding and that it might reduce all-cause mortality. 89 However, this meta-analysis did not include specific (separate) consideration of the pediatric data.…”

Section: Pediatric Patientsmentioning

confidence: 99%

Fibrinogen Supplementation and Its Indications

Grottke

Mallaiah

Karkouti

et al. 2019

Semin Thromb Hemost

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Adequate plasma levels of fibrinogen are essential for clot formation, and in severe bleeding, fibrinogen reaches a critically low plasma concentration earlier than other coagulation factors. Although the critical minimum concentration of fibrinogen to maintain hemostasis is a matter of debate, many patients with coagulopathic bleeding require fibrinogen supplementation. Among the treatment options for fibrinogen supplementation, fibrinogen concentrate may be viewed by some as preferable to fresh frozen plasma or cryoprecipitate. The authors review major studies that have assessed fibrinogen treatment in trauma, cardiac surgery, end-stage liver disease, postpartum hemorrhage, and pediatric patients. Some but not all randomized controlled trials have shown that fibrinogen concentrate can be beneficial in these settings. The use of fibrinogen as part of coagulation factor concentrate based therapy guided by point-of-care viscoelastic coagulation monitoring (ROTEM [rotational thromboelastometry] or TEG [thromboelastography]) appears promising. In addition to reducing patients' exposure to allogeneic blood products, this strategy may reduce the risk of complications such as transfusion-associated circulatory overload, transfusion-related acute lung injury, and thromboembolic adverse events. Randomized controlled trials are challenging to perform in patients with critical bleeding, and more evidence is needed in this setting. However, current scientific rationale and clinical data support fibrinogen repletion in patients with ongoing bleeding and confirmed fibrinogen deficiency.

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Efficacy and Safety of Fibrinogen Concentrate in Surgical Patients: A Meta-Analysis of Randomized Controlled Trials

Cited by 37 publications

References 39 publications

<p>Impact of Incorporation of Fibrinogen Concentrate in Blood Transfusion Management During Liver Transplantation: An Early Local (Single Centre) Experience</p>

<p>Impact of Incorporation of Fibrinogen Concentrate in Blood Transfusion Management During Liver Transplantation: An Early Local (Single Centre) Experience</p>

The epidemiology of multicomponent blood transfusion: a systematic review

Fibrinogen Supplementation and Its Indications

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