The role of fibrinogen concentrate in the reduction of allogeneic blood product requirements: a systematic review and meta-analysis.

Abstract

Background: Fibrinogen concentrate (FC) has a well-established safety profile and is recommended for treating acquired fibrinogen deficiency. However, its comparative effectiveness vs other treatments regarding transfusions and patient outcomes remains uncertain.

Methods: Comparative studies from a range of clinical settings in which patients received FC for acquired hypofibrinogenaemia and that evaluated blood product needs, mortality, thromboembolic events, or hospital length of stay were included in a systematic literature review and meta-analysis (PROSPERO: CRD42024602804). Meta-analyses used pooled data to provide an estimate of the difference in outcome between FC and all other treatments; separate analyses were conducted for adult and paediatric patients.

Results: Overall, 58 studies (N=13 530 patients) were analysed. Adult FC recipients received significantly fewer red blood cell, fresh frozen plasma, and platelet units than with other treatments: 28% (incidence rate ratio [IRR] 0.72; 95% confidence interval [CI] 0.59-0.89; P=0.002), 31% (IRR 0.69; 95% CI 0.54-0.89; P=0.004), and 44% less (IRR 0.56; 95% CI 0.33-0.95; P=0.03), respectively. These results were largely driven by cardiac surgery studies. In an RCT subanalysis, the use and quantity of blood products were significantly reduced with FC. No significant difference in mortality or thromboembolic events was found between treatments in adult patients or in any outcomes analysed in paediatric patients.

Conclusion: This meta-analysis suggests fibrinogen concentrate administered for acquired hypofibrinogenaemia can reduce blood product transfusions in adults, with no obvious safety concerns, compared with other treatments.