- Design
- Systematic review and meta-analysis of comparative studies, with randomised subanalysis
- Population
- 58 studies, 13,530 patients with acquired hypofibrinogenaemia
- Primary outcome
- Allogeneic blood product use
- Effect
- Red cells IRR 0.72 (95% CI 0.59 to 0.89); plasma 0.69; platelets 0.56
A meta-analysis pooled 58 comparative studies of 13,530 patients given fibrinogen concentrate for acquired hypofibrinogenaemia, compared with other treatments such as cryoprecipitate, plasma or standard care. Adults and children were analysed separately.
Adults who received fibrinogen concentrate were given about 28% fewer red cell units (incidence rate ratio 0.72, 95% CI 0.59 to 0.89), 31% fewer plasma units (0.69) and 44% fewer platelet units (0.56). The effect came mostly from cardiac surgery studies, and a subanalysis of randomised trials pointed the same way. Mortality and thromboembolic events did not differ. No differences were found in children.
This supports fibrinogen concentrate as a way to reduce allogeneic exposure when bleeding is driven by low fibrinogen, particularly in cardiac surgery. It does not show a survival benefit.
Most included studies were observational and the comparators varied. In India, cryoprecipitate is cheaper and more widely available, so the choice will often turn on cost, supply and turnaround time rather than effect size alone.
- Measure fibrinogen, by laboratory or viscoelastic testing, in significant surgical bleeding.
- In cardiac surgery with low fibrinogen, consider fibrinogen concentrate to reduce blood product use.
- Mortality and thrombosis did not differ in this analysis.
- Where concentrate is unavailable or costly, cryoprecipitate remains a reasonable source of fibrinogen.
- Evidence in children showed no clear benefit.
Why it matters
Targeting fibrinogen may spare patients several units of donor blood.
Don't overread it
Most studies were observational and the benefit came largely from cardiac surgery; no survival effect was shown.
The statistics, in plain English
An incidence rate ratio of 0.72 means about 28% fewer red cell units given. Because most studies were not randomised, some of this may reflect differences in patients or practice rather than the drug.
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