Fibrinogen concentrates in bleeding trauma patients

Abstract

Background A balanced transfusion of red blood cells, fresh frozen plasma (FFP) and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for FFP and/or platelet transfusions.Aim To provide a review of the literature covering the application of fibrinogen concentrates in trauma care.Methods PubMed and Cochrane database search: fibrinogen and (concentrate or trauma), not congenital, published between 2000 and 2012.Results Six papers were identified. None were randomized controlled trials. The main conclusion of these papers was that administration of fibrinogen sometimes together with prothrombin complex concentrate might improve haemostasis in trauma patients resuscitated with synthetic colloids. Data regarding the effect of fibrinogen concentrate together with a more physiological resuscitation fluid, i.e. FFP, or as the only intervention in bleeding trauma patients is lacking.Conclusions Evidence for the use of fibrinogen concentrate to trauma patients with massive bleeding is sparse, of poor quality and confined to patients resuscitated with synthetic colloids. Well‐designed prospective, randomized, double‐blinded studies evaluating the effect of fibrinogen concentrate, as the only intervention, are urgently needed.