Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review

Abstract

IntroductionHaemostatic therapy in surgical and/or massive trauma patients typically involves transfusion of fresh frozen plasma (FFP). Purified human fibrinogen concentrate may offer an alternative to FFP in some instances. In this systematic review, we investigated the current evidence for the use of FFP and fibrinogen concentrate in the perioperative or massive trauma setting.MethodsStudies reporting the outcome (blood loss, transfusion requirement, length of stay, survival and plasma fibrinogen level) of FFP or fibrinogen concentrate administration to patients in a perioperative or massive trauma setting were identified in electronic databases (1995 to 2010). Studies were included regardless of type, patient age, sample size or duration of patient follow-up. Studies of patients with congenital clotting factor deficiencies or other haematological disorders were excluded. Studies were assessed for eligibility, and data were extracted and tabulated.ResultsNinety-one eligible studies (70 FFP and 21 fibrinogen concentrate) reported outcomes of interest. Few were high-quality prospective studies. Evidence for the efficacy of FFP was inconsistent across all assessed outcomes. Overall, FFP showed a positive effect for 28% of outcomes and a negative effect for 22% of outcomes. There was limited evidence that FFP reduced mortality: 50% of outcomes associated FFP with reduced mortality (typically trauma and/or massive bleeding), and 20% were associated with increased mortality (typically surgical and/or nonmassive bleeding). Five studies reported the outcome of fibrinogen concentrate versus a comparator. The evidence was consistently positive (70% of all outcomes), with no negative effects reported (0% of all outcomes). Fibrinogen concentrate was compared directly with FFP in three high-quality studies and was found to be superior for > 50% of outcomes in terms of reducing blood loss, allogeneic transfusion requirements, length of intensive care unit and hospital stay and increasing plasma fibrinogen levels. We found no fibrinogen concentrate comparator studies in patients with haemorrhage due to massive trauma, although efficacy across all assessed outcomes was reported in a number of noncomparator trauma studies.ConclusionsThe weight of evidence does not appear to support the clinical effectiveness of FFP for surgical and/or massive trauma patients and suggests it can be detrimental. Perioperatively, fibrinogen concentrate was generally associated with improved outcome measures, although more high-quality, prospective studies are required before any definitive conclusions can be drawn.

Inappropriateness of fresh frozen plasma for abnormal coagulation tests

“…Recent studies have attempted this in different settings (including paediatrics) and confirmed the ongoing inappropriate use of FFP for abnormal coagulation screening. 24,25 The Royal College of Physicians of Edinburgh has a unique blend of rooms providing the perfect location for your conference, meeting or event. The Victorian Great Hall, galleried New Library and the Georgian Cullen Suite are wonderful settings for dinners and receptions.…”

Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial

“…4 Thus, restoration of adequate fibrinogen concentrations plays a major role in maintenance of effective haemostasis. As in most European countries cryoprecipitate is not available, and fresh frozen plasma (FFP) has demonstrated questionable efficacy in restoring diminished fibrinogen concentrations after perioperative bleeding, [8][9][10] administration of purified fibrinogen concentrate has become the standard of care in a number of countries, including Switzerland. Fibrinogen concentrate is recommended in the current European guidelines for perioperative bleeding management, 11 although data in children are rare.…”

An Audit of Fresh Frozen Plasma Usage in a Tertiary Trauma Care Centre in North India

“…to identify and analyze all RCTs examining the clinical effectiveness of FFP, reported that the strongest RCT evidence indicates that the prophylactic use of FFP is not significantly or consistently effective across a range of different selected clinical settings. Recently similar review by Kozek-Langenecker et al [24]. concluded that the published evidence does not appear to support the clinical Fig.…”