Systematic review of the use of fibrin sealant to minimize perioperative allogeneic blood transfusion.
BACKGROUND
Fibrin sealants have become popular in improving perioperative haemostasis and reducing the need for allogeneic red cell transfusion.


METHODS
A systematic review of randomized controlled trials was conducted to examine the efficacy of fibrin sealants in reducing perioperative blood loss and allogeneic red blood cell transfusion. Studies were identified by computer searches of Medline, Embase, Current Contents, the Cochrane Library, manufacturer websites (to January 2001), and bibliographic searches of published articles. Trials were eligible for inclusion if they involved adult elective surgery and reported quantitative data on blood loss, the proportion of patients exposed to allogeneic red cell transfusion and/or the volume of blood transfused.


RESULTS
Twelve trials met the criteria for inclusion. Fibrin sealants reduced the rate of allogeneic blood transfusion (relative risk 0.40 (95 per cent confidence interval (c.i.) 0.26 to 0.61); five trials with 275 subjects) and reduced blood loss (weighted mean difference--151.68 (95 per cent c.i. - 251.91 to - 51.46) ml; seven trials with 391 subjects). Generally, the trials were small and of poor methodological quality.


CONCLUSIONS
Overall the results suggest that fibrin sealants are efficacious. Owing to lack of blinding, transfusion practices may have been influenced by knowledge of the patient's treatment status. This raises concern about blood transfusion practice as a response variable. Large methodologically rigorous trials of fibrin sealants with clinical outcomes are needed.
Carless
P A
PA
School of Population Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia. pcarless@mail.newcastle.edu.au
Anthony
D M
DM
Henry
D A
DA
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000379:methods*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D014014:Tissue Adhesives / Q000627:therapeutic use*
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014014:Tissue Adhesives