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Fibrinogen concentrate in bleeding patients

  1. Anne Wikkelsø1,*,
  2. Jens Lunde2,
  3. Mathias Johansen3,
  4. Jakob Stensballe4,
  5. Jørn Wetterslev5,
  6. Ann Merete Møller6,
  7. Arash Afshari7,8

Editorial Group: Cochrane Anaesthesia Group

Published Online: 29 AUG 2013

Assessed as up-to-date: 9 AUG 2013

DOI: 10.1002/14651858.CD008864.pub2


How to Cite

Wikkelsø A, Lunde J, Johansen M, Stensballe J, Wetterslev J, Møller AM, Afshari A. Fibrinogen concentrate in bleeding patients. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008864. DOI: 10.1002/14651858.CD008864.pub2.

Author Information

  1. 1

    University of Copenhagen Herlev Hospital, Department of Anaesthesiology, Herlev, Denmark

  2. 2

    Rigshospitalet, Copenhagen University Hospital, Juliane Marie Centre - Anaesthesia and Surgical Clinic Department 4013, Copenhagen, Denmark

  3. 3

    Rigshospitalet, Copenhagen University Hospital, Department of Anaesthesiology, Centre of Neuroanaesthesia, Copenhagen, Denmark

  4. 4

    Copenhagen University Hospital, Rigshospitalet, Department of Anaesthesiology, Centre of Head and Orthopaedics & Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen, Denmark

  5. 5

    Rigshospitalet, Copenhagen University Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Copenhagen, Denmark

  6. 6

    University of Copenhagen Herlev Hospital, The Cochrane Anaesthesia Review Group, Rigshospitalet & Department of Anaesthesiology, Herlev, Denmark

  7. 7

    Hôpitaux Universitaires de Genève, Pediatric and Neonatal Intensive Care Service, Geneva, Switzerland

  8. 8

    Rigshospitalet, Copenhagen University Hospital, Juliane Marie Centre, Department of Anaesthesiology, Copenhagen, Denmark

*Anne Wikkelsø, Department of Anaesthesiology, University of Copenhagen Herlev Hospital, Herlev, Denmark. wikkelso@gmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 29 AUG 2013

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[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 3]
Figure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 4]
Figure 4. Trial sequential analysis of the effect of fibrinogen concentrate on the proportion of participants transfused using a control event proportion of 76% found in the included trials cumulated control groups. The diversity (58%) adjusted required information size for an anticipated intervention effect of 28% derived from the upper confidence limit of the RR (0.31 to 0.72) estimated in the traditional meta-analysis is 374. The trial sequential monitoring boundary for benefit is crossed indicating lack of random error for the conclusion of an effect of 28% relative risk reduction even though the required information size has not been reached. However, risk of bias may have overestimated the intervention effect in the traditional meta-analysis, so the results shall be interpreted with caution.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 1 Mortality longest follow-up.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 2 ICU stay (hours).
[Analysis 1.3]
Analysis 1.3. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 3 Duration of mechanical ventilation (hours).
[Analysis 1.4]
Analysis 1.4. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 4 Stay in hospital (days).
[Analysis 1.5]
Analysis 1.5. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 5 Incidence of allogenic blood transfusion (types of comparison).
[Analysis 1.6]
Analysis 1.6. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 6 Incidence of allogenic blood transfusion (cardiac vs non-cardiac).
[Analysis 1.7]
Analysis 1.7. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 7 Incidence of allogenic blood transfusion (pediatric vs adult).
[Analysis 1.8]
Analysis 1.8. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 8 Incidence of allogenic blood transfusion (high dose > 50 mg/kg vs low dose).
[Analysis 1.9]
Analysis 1.9. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 9 Re-operation due to persistent bleeding.
[Analysis 1.10]
Analysis 1.10. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 10 Incidence of RBC transfusion longest follow-up.
[Analysis 1.11]
Analysis 1.11. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 11 Thrombotic episodes (arterial and venous graft occlusion, pulmonary embolus, deep venous thrombosis).
[Analysis 1.12]
Analysis 1.12. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 12 Complications not specific to trial intervention (pleural effusion, abdominal ischaemia and other serious adverse events).
[Analysis 1.13]
Analysis 1.13. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 13 Blood loss/drainage, longest follow-up.
[Analysis 1.14]
Analysis 1.14. Comparison 1 Fibrinogen concentrate versus any comparator, Outcome 14 Blood loss/Drainage (24 hours) mL/kg/h.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Fibrinogen versus placebo or no treatment, Outcome 1 Incidence of allogenic blood transfusion (cardiac vs non-cardiac).