Fibrinogen concentrate for bleeding--a systematic review

Published on Oct 1, 2014in Acta Anaesthesiologica Scandinavica2.105
· DOI :10.1111/AAS.12370
Jens Lunde4
Estimated H-index: 4
(Copenhagen University Hospital),
Jakob Stensballe34
Estimated H-index: 34
(Copenhagen University Hospital)
+ 2 AuthorsArash Afshari32
Estimated H-index: 32
(Copenhagen University Hospital)
Sources
Abstract
Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were determined to be of high risk of bias and none reported a significant effect on mortality. Two RCTs found a significant reduction in bleeding and five RCTs found a significant reduction in transfusion requirements. The 23 non-randomised studies included a total of 2825 patients, but only 11 of 23 studies included a control group. Three out of 11 found a reduction in transfusion requirements while mortality was reduced in two and bleeding in one. In the available RCTs, which all have substantial shortcomings, we found a significant reduction in bleeding and transfusions requirements. However, data on mortality were lacking. Weak evidence from RCTs supports the use of fibrinogen concentrate in bleeding patients, primarily in elective cardiac surgery, but a general use of fibrinogen across all settings is only supported by non-randomised studies with serious methodological shortcomings. It seems pre-mature to conclude whether fibrinogen concentrate has a routine role in the management of bleeding and coagulopathic patients. More RCTs are urgently warranted.
📖 Papers frequently viewed together
References66
Newest
#1Jakob Stensballe (Copenhagen University Hospital)H-Index: 34
#2Sisse R. OstrowskiH-Index: 53
Last. Pär I. JohanssonH-Index: 67
view all 3 authors...
Purpose of reviewBleeding in trauma carries a high mortality and is increased in case of coagulopathy. Our understanding of hemostasis and coagulopathy has improved, leading to a change in the protocols for hemostatic monitoring. This review describes the current state of evidence supporting the use
Source
#1Kenichi A. TanakaH-Index: 27
#2Katherine Egan (Emory University)H-Index: 2
Last. Edward P. ChenH-Index: 32
view all 8 authors...
Background Platelet (PLT) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (FIB) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first-line FIB replacement and PLT transfusion in post–cardiac surgical bleeding. Study Design and Methods In this prospective, randomized, open-label study, 20 adul...
Source
Summary Three decades ago, transfusion-related acute lung injury (TRALI) was considered a rare complication of transfusion medicine. Nowadays, the US Food and Drug Administration acknowledge the syndrome as the leading cause of transfusion-related mortality. Understanding of the pathogenesis of TRALI has resulted in the design of preventive strategies from a blood-bank perspective. A major breakthrough in efforts to reduce the incidence of TRALI has been to exclude female donors of products with...
Source
Bleeding complications after cardiac surgery are of particular importance in children because they are more prone to volume overload. To optimize haemostatic intervention, the coagulopathy has to be characterized, and knowledge about the effect of blood products and haemostatic agents is needed. The
Source
#1Anne Wikkelsø (UCPH: University of Copenhagen)H-Index: 9
#2Jens Lunde (Copenhagen University Hospital)H-Index: 4
Last. Arash AfshariH-Index: 32
view all 7 authors...
Background Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic deficiencies in several countries, but evidence is lacking regarding indications, dosing, efficacy and safety. Objectives We assessed the benefits and harms of fibrinogen concentrate compared wit...
Source
#1Lucy YangH-Index: 8
#2Alain Vuylsteke (Papworth Hospital)H-Index: 21
Last. Trevor BaglinH-Index: 68
view all 5 authors...
Summary Background: Traditionally, a fibrinogen level > 1 g L−1 has been viewed as the critical plasma concentration required for hemostasis. No definitive trial has investigated the plasma fibrinogen hemostatic threshold and fibrinogen replacement in complex surgical patients with acquired bleeding. Objectives: To explore the plasma fibrinogen level required for hemostasis in cardiothoracic surgery patients and assess the association of fibrinogen replacement therapy (using cryoprecipitate or f...
Source
#2Arash Afshari (UCPH: University of Copenhagen)H-Index: 32
Last. Piet Wyffels (UGent: Ghent University)H-Index: 8
view all 22 authors...
The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient’s tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality a...
Source
#1Christian Fenger-Eriksen (Aarhus University Hospital)H-Index: 15
#2Kirsten Christiansen (Aarhus University Hospital)H-Index: 11
Last. Catherine J. Rea ('KCL': King's College London)H-Index: 8
view all 5 authors...
Abstract Introduction Fibrinogen deficiency often develops during massive bleeding due to e.g. fluid resuscitation with colloid plasma expanders like hydroxyethyl starch. This study investigates the haemostatic effect of various sources of fibrinogen: fibrinogen concentrates (Haemocomplettan® (FC 1), CSL Behring and Clottagen® (FC 2), LFB Biomedicaments), fresh frozen plasma (FFP), and Cryoprecipitate (CP). Methods Whole blood samples provided by healthy individuals (n = 8) were diluted 1:1 with...
Source
Introduction: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved. Methods: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010....
Source
#1Mariko Kikuchi (Saitama Medical University)H-Index: 2
#2Atsuo Itakura (Saitama Medical University)H-Index: 27
Last. Osamu Ishihara (Saitama Medical University)H-Index: 30
view all 6 authors...
Aim The aim of this study was to assess the efficacy and safety of fibrinogen concentrate therapy for women with obstetric hemorrhage complicated by dilutional or consumptive coagulopathy by retrospectively reviewing the medical records of relevant patients from a single tertiary center. Material and Methods Eighteen cases of coagulopathy (8 dilutional, 10 consumptive) administered fibrinogen concentrate at our center over the past 5 years for treating hypofibrinogenemia were identified. Hemoglo...
Source
Cited By50
Newest
Bleeding is frequently seen in critically ill children and is associated with increased morbidity and mortality. Fibrinogen is an essential coagulation factor for hemostasis and hypofibrinogenemia is an important risk factor for bleeding in pediatric and adult settings. Cryoprecipitate and fibrinogen concentrate are often given to critically ill children to prevent bleeding and improve fibrinogen levels, especially in the setting of surgery, trauma, leukemia, disseminated intravascular coagulopa...
Source
#1Lena M. Napolitano (UM: University of Michigan)H-Index: 72
Acute hemorrhage is a global healthcare issue, and remains the leading preventable cause of death in trauma. Acute severe hemorrhage can be related to traumatic, peripartum, gastrointestinal, and p...
Source
#1Sarah N Stabler (Surrey Memorial Hospital)H-Index: 5
#2Siying Shari LiH-Index: 1
Last. Erik N. Vu (UBC: University of British Columbia)H-Index: 5
view all 4 authors...
BACKGROUND Trauma-induced coagulopathy contributes to significant morbidity and mortality in patients who experience trauma-related bleeding. This study aimed to synthesize the evidence supporting the efficacy and safety of preemptive and goal-directed fibrinogen concentrate (FC) in the management of trauma-related hemorrhage. METHODS PubMed, Medline, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the WHO I...
Source
#1Kristina Siemens (Boston Children's Hospital)H-Index: 2
#2Beverley J. Hunt (St Thomas' Hospital)H-Index: 83
Last. Shane M. Tibby (Boston Children's Hospital)H-Index: 38
view all 6 authors...
Background: Mediastinal bleeding is common following pediatric cardiopulmonary bypass surgery for congenital heart disease. Fibrinogen concentrate (FC) represents a potential therapy for preventing...
Source
Aim. To assess the effect of fibrin monomer on the rate of blood loss after controlled liver injury in hypofibrinoge­nemia induced by systemic administration of Malayan pit viper venom (Agkistrodon rhodostoma). Methods. A placebo-controlled study of the hemostatic effect of fibrin monomer administered intravenously at 0.25 mg/kg, and coagulation parameters in the controlled liver injury with profound hypofibrinogenemia caused by administration of Malayan pit viper venom was conducted in 34 male ...
Source
#1Sharon Maconachie (Boston Children's Hospital)H-Index: 1
#2Melanie Jansen (Children's Hospital at Westmead)H-Index: 3
Last. S. George (Griffith University)H-Index: 135
view all 7 authors...
OBJECTIVE: Haemorrhage in paediatric trauma remains a significant cause of morbidity and mortality. Over recent years there has been increasing attention to the role of fibrinogen in traumatic haemorrhage and the association of low fibrinogen levels with poor patient outcomes. In addition, there has been a move towards using viscoelastic haemostatic assays (VHAs) to rapidly assess coagulation status and guide clinicians in the replacement of coagulation factors, including fibrinogen. In the paed...
Source
While deferoxamine (DFO) has long been used as an FDA-approved iron chelator, its proangiogenesis ability attracts increasing number of research interests. To address its drawbacks such as short plasma half-life and toxicity, polymeric conjugated strategy has been proposed and shown superiority. Owing to intravenous injection and application in blood-related conditions, however, the blood interactions and antioxidation of the DFO-conjugates and the mechanisms underlying these outcomes remain to ...
Source
#1Abbas Zaidi (QMUL: Queen Mary University of London)H-Index: 2
#2Ruchika Kohli (QMUL: Queen Mary University of London)H-Index: 1
Last. Laura E. GreenH-Index: 67
view all 7 authors...
Abstract Fibrinogen levels drop early in postpartum hemorrhage (PPH), and low fibrinogen levels predict outcomes. There is increasing interest in replacing fibrinogen early in severe PPH and this systematic review’s aim was to assess if early fibrinogen replacement therapy improves outcomes in severe PPH. We searched the following databases from inception to June 2019: CDSR and CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, PubMed, Transfusion Evidence Library, LILACS, Web of Science C...
Source
#1Lou M. Almskog (KI: Karolinska Institutet)H-Index: 3
#2Ulf Hammar (KI: Karolinska Institutet)H-Index: 15
Last. Anna Ågren (KI: Karolinska Institutet)H-Index: 5
view all 7 authors...
Background Fibrinogen concentrate (FC) is frequently used to treat bleeding trauma patients, although the clinical effects are not well known. In this study we describe demographic and clinical outcome data in a cohort of trauma patients receiving FC, compared to a matched control group, who did not receive FC.
Source
#1Jez Fabes (Royal Free Hospital)
#2Simon J. Stanworth (NHSBT: NHS Blood and Transplant)H-Index: 72
This chapter summarises the evidence base for use of tranexamic acid, prothrombin complex concentrate (PCC), fibrinogen concentrate, cryoprecipitate and recombinant Factor VII a in trauma.
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.