Use of lyophilized fibrinogen concentrate in cardiac surgery: a systematic review

INTRODUCTION: Use of fibrinogen concentrate among cardiac anesthetists is growing especially for the benefits related to the reduction in the administration of bleeding and allogeneic blood components, which are exacerbated by cardiopulmonary bypass. Moreover, these products underwent complete viral inactivation, reducing the risks of contamination associated with transfusion. The purpose of this research was to review the literature looking for randomized controlled trials regarding fibrinogen concentrate and its benefits in cardiac surgery. METHOD: The papers used in this review were searched in BioMed Central, PubMed, Embase, and the Cochrane Central Register of Clinical Trial by two investigators. The full search strategy was performed to identify all randomized controlled trials in the last 10 years, comparing the use of fibrinogen in the adult treatment of perioperative bleeding to standard treatment or placebo. RESULTS: Only four articles matching the selection criteria for final analysis were identified and only 79 patients received therapy with fibrinogen concentrate in randomized trials performed in cardiac surgery. CONCLUSIONS: During the last 10 years, few randomized controlled trials were performed to confirm the real benefit of using lyophilized fibrinogen to reduce bleeding in cardiac surgery. However, when indicated, it may be a good option in order to reduce the consumption of blood products in the treatment of perioperative bleeding, following an algorithm based on point-of-care testing.