The role of fibrinogen concentrate in the reduction of allogeneic blood product requirements: a systematic review and meta-analysis.
Niels Rahe-Meyer, Roseny Rodrigues, Dietmar Fries et al.
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In 30 seconds
This systematic review and meta-analysis compared fibrinogen concentrate (FC) with other treatments for acquired hypofibrinogenaemia across clinical settings. It included 58 studies involving 13 530 patients, with separate analyses for adults and children. In adults, FC was associated with lower use of red blood cell, fresh frozen plasma, and platelet units; the respective incidence rate ratios were 0.72, 0.69, and 0.56. The reductions were largely driven by cardiac surgery studies. No significant differences in mortality or thromboembolic events were found in adults, and no analysed outcomes differed significantly in paediatric patients.
Key findings
- In adults, red blood cell use was 28% lower with FC than with other treatments (IRR 0.72; 95% CI 0.59-0.89; P=0.002).
- Fresh frozen plasma use was 31% lower (IRR 0.69; 95% CI 0.54-0.89; P=0.004), and platelet use was 44% lower (IRR 0.56; 95% CI 0.33-0.95; P=0.03).
- The transfusion reductions were largely driven by cardiac surgery studies; an RCT subanalysis also found significantly reduced blood product use and quantity with FC.
- No significant differences in mortality or thromboembolic events were found in adults, and no analysed outcomes differed significantly in paediatric patients.
Why it matters
Reducing allogeneic blood product use may be clinically relevant when treating acquired hypofibrinogenaemia. This synthesis suggests FC may reduce transfusion requirements in adults, particularly in evidence largely driven by cardiac surgery, while reported mortality and thromboembolic outcomes did not differ significantly. The findings help frame FC’s comparative effectiveness alongside its established role in treating fibrinogen deficiency.
What to keep in mind
The transfusion reductions were largely driven by cardiac surgery studies, limiting how confidently they can be generalised across other clinical settings. The abstract does not report significant outcome differences in paediatric patients.