Photo Credit: libre de droit

The following is a summary of “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,” published in the January 2025 issue of Critical Care by Burt et al. 

Severe trauma-related hypofibrinogenemia is linked to higher mortality, with no established guidelines on optimal fibrinogen dosing or timing.  

Researchers conducted a retrospective study to evaluate the impact of early fibrinogen replacement, using either cryoprecipitate or fibrinogen concentrate (FgC), on mortality, transfusion needs, and deep venous thrombosis (DVT).  

They performed a systematic search on MEDLINE, EMBASE, and clinicaltrials.gov using standardized criteria. Studies examining the use of cryoprecipitate or FgC in patients with traumatic hemorrhage within 4 hours of hospital admission were included. Mortality (28-day, 30-day, or in-hospital) was the primary outcome, with secondary outcomes being DVT incidence and blood transfusion requirements. Narrative synthesis was applied to observational studies, while meta-analysis was used for Randomized control trials (RCTs) on mortality, with sub-group analysis for FgC and cryoprecipitate. The Grading of Recommendations Assessment, Development, and Evaluation was used to assess evidence quality.  

The results showed 1,906 studies were screened, with 12 studies included, comprising 5 RCTs with 1,758 participants, 3 RCTs used FgC, and 2 used cryoprecipitate while 4 out of 5 RCTs evaluated empiric fibrinogen replacement for suspected traumatic hemorrhage. There was no significant difference in mortality: early fibrinogen replacement (24%) vs control (25%), (OR) 1.03 (95% CI; 0.68–1.56). Subgroup analysis also showed no difference in outcomes between FgC and control (18.1% vs 10.9%, OR 1.99, 95% CI; 0.80–4.94) or between cryoprecipitate and control (24.9% vs 26.1%, OR 0.71, 95% CI; 0.25–2.01). Meta-analysis could not be performed on transfusion data. There was no difference in DVT incidence: fibrinogen replacement (3%) vs control (4%), OR 0.73 (95% CI; 0.43–1.25). The overall quality of evidence was graded as low due to indirectness and imprecision.  

Investigators concluded the early fibrinogen replacement showed no connection with mortality, DVT, or transfusion requirements and emphasized the need for further RCTs to evaluate its efficacy and optimal therapeutic strategies. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05269-y