The effect of fibrinogen concentrate on postoperative blood loss: A systematic review and meta-analysis of randomized controlled trials

Authors: Ng, K. T., Yap, J. L. L., and Kwok, P. E.

Publication: J Clin Anesth; 63, March 2020

Affiliations: Department of Anaesthesiology, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia; Department of Surgery, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada.

Abstract: BACKGROUND: Low level of fibrinogen is a risk factor of perioperative bleeding, which is a major complication in surgical patients. However, the safety and efficacy of fibrinogen supplementation with fibrinogen concentrate to minimize postoperative bleeding remains unclear. OBJECTIVES: The primary aim of this review was to investigate the effect of fibrinogen concentrate in postoperative blood loss in adult surgical patients. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Databases of MEDLINE, EMBASE and CENTRAL were searched from their start date until July 2019. ELIGIBILITY CRITERIA: All randomized clinical trials comparing intravenous fibrinogen concentrate and placebo in adult surgical patients were included, regardless of type of surgery. Observational studies, case reports, case series and non-systematic reviews were excluded. RESULTS: Thirteen trials (n = 900) were included in this review. In comparison to placebo, fibrinogen concentrate significantly reduced the first 12-hour postoperative blood loss, with a mean difference of -134.6 ml (95% CI -181.9 to -87.4). It also significantly increased clot firmness in thromboelastometry (FIBTEM) with a mean difference of 2.5 mm (95%CI 1.1 to 3.8). No significant differences were demonstrated in the adverse events associated with fibrinogen concentrate use, namely incidence of thromboembolism, myocardial infarction and acute kidney injury. CONCLUSIONS: In this meta-analysis of 13 randomized trials, low level of evidence and substantial heterogeneity with small sample size limit strong recommendation on the use of fibrinogen concentrate in adult surgical patients. However, its use is tolerable without any notable adverse events. TRIAL REGISTRATION: CRD42019149164.