Effect of early administration of fibrinogen replacement therapy in traumatic haemorrhage: a systematic review and meta-analysis of randomised controlled trials with narrative synthesis of observational studies

Burt, T; Guilliam, A; Cole, E; Davenport, R

doi:10.1186/s13054-025-05269-y

Effect of early administration of fibrinogen replacement therapy in traumatic haemorrhage: a systematic review and meta-analysis of randomised controlled trials with narrative synthesis of observational studies

Crit CarePublished 28 Jan 2025Systematic review and meta-analysis of randomised controlled trials with narrative synthesis of observational studies

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Authors' conclusion

There is no association between early fibrinogen replacement and mortality, DVT or transfusion requirements. We found no superiority between FgC or cryoprecipitate.

Study context

Population: Trauma patients with traumatic haemorrhage
Participants: 1,758 patients · 5 RCTs

Comparison: Early fibrinogen replacement vs control
Outcome: Mortality (28-day, 30-day or in-hospital)

Methodological detailspre-defined subgroup analysis, GRADE quality assessment, 1906 studies screened, 12 included; 3 RCTs fibrinogen concentrate (FgC), 2 cryoprecipitate

Pre-defined subgroup analysis
GRADE quality assessment
1906 studies screened, 12 included; 3 RCTs FgC, 2 cryoprecipitate

Pooled result

As reported in the abstract

Odds ratio

1.03

95% CI 0.68–1.56

By group

Early fibrinogen replacement24%

Control25%

Early fibrinogen replacement vs Control

OR 1.03 (95% CI 0.68–1.56)

Further pooled results

Outcome	Control	← Lower odds vs control ←→ Higher odds vs control →	OR (95% CI)
Mortality, FgC subgroupFgC vs Control	10.9%	0.20.5125	1.99 (0.80–4.94)
Mortality, cryoprecipitate subgroupCryoprecipitate vs Control	26.1%	0.20.5125	0.71 (0.25–2.01)
		0.20.5125Odds ratio (log scale)

Mortality, FgC subgroup: FgC 18.1%
Mortality, cryoprecipitate subgroup: Cryoprecipitate 24.9%

Transfusion requirements

Reporting of transfusion data precluded meta-analysis

Safety

Outcome	Early fibrinogen replacement	Control	← Lower odds with early fibrinogen replacement ←→ Higher odds with early fibrinogen replacement →	OR (CI)
DVT incidence	3%	4%	0.512	0.73 (0.43–1.25)
			0.512Odds ratio (log scale)

Original publication

Effect of early administration of fibrinogen replacement therapy in traumatic haemorrhage: a systematic review and meta-analysis of randomised controlled trials with narrative synthesis of observational studies. Crit Care. Published 28 January 2025. doi:10.1186/s13054-025-05269-y

Read the original article ↗

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