Background Acute traumatic coagulopathy (ATC) is present in a quarter of severely injured patients and is associated with worse outcomes.(1–3) Fibrinogen is the first clotting protein to become deficient in ATC and there is a suggestion that supplementary fibrinogen may improve outcomes in these patients.(1, 4, 5) This review aimed to explore the efficacy and safety profile of fibrinogen concentrate (FC) administration to patients suffering from traumatic haemorrhage.

Methods A comprehensive search of Medline, Embase and the Cochrane Library databases was performed. Studies were included if they compared FC administration with a suitable comparator group in adults suffering from traumatic haemorrhage. Only randomised controlled trials, quasi-experimental or cohort studies were included at the screening stage. Included papers were analysed by narrative review.

Results 271 studies were identified and screened of which 8 were included. Mortality data was conflicting and of poor overall quality. Four of the studies reported a survival benefit with FC administration,(6–9) one reported a higher ICU mortality,(10) and the remaining studies found no significant difference relative to the comparators.(11, 12) All studies exploring the effect of FC on plasma fibrinogen levels found a significant increase to normal levels in the FC group at 2 hours post intervention.(11–13) One study demonstrated that this effect lasted for twelve hours after receiving FC.(11) There was no increase in the incidence of thromboembolic events in patients treated with FC compared to standard care.

Conclusion FC is effective at reversing hypofibrinogenaemia in the setting of ATC and does not appear to increase the risk of thromboembolic events. Mortality data remains conflicted and of poor overall quality, therefore it is unclear if these affects correspond to improved clinical outcomes. Randomised controlled trials adequately powered to detect a mortality difference are recommended before the clinical efficacy of FC in traumatic haemorrhage can be established.