- Design
- Systematic review and meta-analysis of comparative studies
- Population
- 13,530 patients in 58 studies with acquired hypofibrinogenaemia
- Primary outcome
- Allogeneic blood product use
- Effect
- Adults: red cells IRR 0.72 (95% CI 0.59 to 0.89); plasma IRR 0.69; platelets IRR 0.56
This meta-analysis pooled 58 comparative studies, 13,530 patients, in which fibrinogen concentrate was given for acquired hypofibrinogenaemia and compared with other treatments, chiefly plasma or cryoprecipitate.
Adults given fibrinogen concentrate received about 28% fewer red cell units (IRR 0.72), 31% fewer plasma units (IRR 0.69) and 44% fewer platelet units (IRR 0.56). The effect was driven mostly by cardiac surgery studies, and a subanalysis of randomised trials pointed the same way. Mortality and thromboembolic events did not differ. No differences were seen in children.
Most included studies were not randomised, and the comparator varied, though the protocol was registered in advance.
In practice, this supports targeted fibrinogen replacement guided by a measured level or viscoelastic testing in cardiac surgical bleeding. Cost and availability matter in India, where cryoprecipitate is often the realistic option.
- Measure fibrinogen or use viscoelastic testing to guide replacement in surgical bleeding
- Consider fibrinogen concentrate where available for acquired hypofibrinogenaemia in cardiac surgery
- Cryoprecipitate remains a valid source of fibrinogen where concentrate is unavailable or unaffordable
- No increase in thromboembolic events was seen
Why it matters
It strengthens the case for targeted fibrinogen replacement over empirical plasma.
Don't overread it
Most included studies were not randomised, so confounding may explain part of the reduction.
The statistics, in plain English
An incidence rate ratio of 0.72 means about 28% fewer units transfused. Because most studies were observational and mostly from cardiac surgery, the result may not apply to trauma or obstetric bleeding.
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