The occurrence of massive haemorrhages in various emergency situations increases the need for blood transfusions and increases the risk of mortality. Fibrinogen concentrate (FC) use may increase plasma fibrinogen levels more rapidly than fresh-frozen product or cryoprecipitate use. Previous several systematic reviews and meta-analyses have not effectively demonstrated FC efficacy in significantly improving the risk of mortality and reducing transfusion requirements. In this study, we investigated the use of FC for haemorrhages in emergency situations. In this systematic review and meta-analysis, we included controlled trials, but excluded randomized controlled trials (RCTs) in elective surgeries. The study population consisted of patients with haemorrhages in emergency situations, and the intervention was emergency supplementation of FC. The control group was administered with ordinal transfusion or placebo. The primary and secondary outcomes were in-hospital mortality and the amount of transfusion and thrombotic events, respectively. The electronic databases searched included MEDLINE (PubMed), Web of Science, and the Cochrane Central Register of Controlled Trials. Nine RCTs in the qualitative synthesis with a total of 701 patients were included. Results showed a slight increase in in-hospital mortality with FC treatment (RR 1.24, 95% CI 0.64–2.39, p = 0.52) with very low certainty of the evidence. There was no reduction in the use of red blood cells (RBC) transfusion in the first 24 h after admission with FC treatment (mean difference [MD] 0.0 Unit in the FC group, 95% CI − 0.99–0.98, p = 0.99) with very low certainty of the evidence. However, the use of fresh-frozen plasma (FFP) transfusion significantly increased in the first 24 h after admission with FC treatment (MD 2.61 Unit higher in the FC group, 95% CI 0.07–5.16, p = 0.04). The occurrence of thrombotic events did not significantly differ with FC treatment. The present study indicates that the use of FC may result in a slight increase in in-hospital mortality. While FC did not appear to reduce the use of RBC transfusion, it likely increased the use of FFP transfusion and may result in a large increase in platelet concentrate transfusion. However, the results should be interpreted cautiously due to the unbalanced severity in the patient population, high heterogeneity, and risk of bias.

中文翻译：

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紧急给予纤维蛋白原浓缩物治疗出血：系统评价和荟萃分析

各种紧急情况下大出血的发生增加了输血的需要并增加了死亡风险。与使用新鲜冷冻产品或冷沉淀物相比，使用纤维蛋白原浓缩物 (FC) 可以更快地增加血浆纤维蛋白原水平。之前的几项系统评价和荟萃分析并未有效证明 FC 在显着提高死亡率风险和减少输血需求方面的功效。在这项研究中，我们调查了在紧急情况下使用 FC 治疗出血的情况。在此系统评价和荟萃分析中，我们纳入了对照试验，但排除了择期手术的随机对照试验 (RCT)。研究人群由紧急情况下的出血患者组成，干预措施是紧急补充 FC。对照组给予序贯输血或安慰剂。主要和次要结果分别是院内死亡率以及输血和血栓事件的数量。搜索的电子数据库包括 MEDLINE (PubMed)、Web of Science 和 Cochrane Central Register of Controlled Trials。纳入了 9 项定性综合随机对照试验，共 701 名患者。结果显示，FC 治疗的住院死亡率略有增加（RR 1.24，95% CI 0.64–2.39，p = 0.52），证据质量非常低。在接受 FC 治疗后的前 24 小时内，红细胞 (RBC) 输注的使用没有减少（FC 组的平均差异 [MD] 0.0 单位，95% CI − 0.99–0.98，p = 0.99）证据的质量非常低。然而，在接受 FC 治疗后的前 24 小时内，新鲜冷冻血浆 (FFP) 输注的使用显着增加（FC 组的 MD 高出 2.61 个单位，95% CI 0.07–5.16，p = 0.04）。血栓事件的发生与 FC 治疗没有显着差异。本研究表明，使用 FC 可能会导致院内死亡率略有增加。虽然 FC 似乎没有减少红细胞输注的使用，但它可能增加了 FFP 输注的使用，并可能导致浓缩血小板输注的大量增加。然而，由于患者人群的严重程度不平衡、高度异质性和偏倚风险，应谨慎解释结果。p = 0.04）。血栓事件的发生与 FC 治疗没有显着差异。本研究表明，使用 FC 可能会导致院内死亡率略有增加。虽然 FC 似乎没有减少红细胞输注的使用，但它可能增加了 FFP 输注的使用，并可能导致浓缩血小板输注的大量增加。然而，由于患者人群的严重程度不平衡、高度异质性和偏倚风险，应谨慎解释结果。p = 0.04）。血栓事件的发生与 FC 治疗没有显着差异。本研究表明，使用 FC 可能会导致院内死亡率略有增加。虽然 FC 似乎没有减少红细胞输注的使用，但它可能增加了 FFP 输注的使用，并可能导致浓缩血小板输注的大量增加。然而，由于患者人群的严重程度不平衡、高度异质性和偏倚风险，应谨慎解释结果。它可能增加了 FFP 输注的使用，并可能导致浓缩血小板输注的大量增加。然而，由于患者人群的严重程度不平衡、高度异质性和偏倚风险，应谨慎解释结果。它可能增加了 FFP 输注的使用，并可能导致浓缩血小板输注的大量增加。然而，由于患者人群的严重程度不平衡、高度异质性和偏倚风险，应谨慎解释结果。