title: The desperate need for good-quality clinical trials to evaluate the optimal source and dose of fibrinogen in managing bleeding.
abstract: Recent interest in transfusion management of trauma patients has heightened expectation in the role of blood component therapy in improving patient outcome. Optimal transfusion support in supplementation with fibrinogen has not been defined by high-quality evidence. Current evidence comes mainly from case series and uncontrolled studies and does not support the superiority of one source of fibrinogen over another or the optimal schedule or dose for patient benefit. There are unanswered questions about safety, especially the effects on the risk of hospital-acquired venous thromboembolism, an important consideration in any therapy that alters the hemostatic balance. Studies of cost-effectiveness have not been considered in research. An international move to supplement fibrinogen more 'aggressively' without direct clinical evaluation beforehand represents a failed opportunity to improve our very limited understanding of optimal transfusion practice.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Stanworth
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Hunt
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D005340:Fibrinogen / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D010949:Plasma; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D006490:Hemostatics; D005340:Fibrinogen
references.citation: Crit Care. 2011;15(5):R239
references.pmid: 21999308
references.citation: PLoS Med. 2009 Jul 21;6(7):e1000097
references.pmid: 19621072
references.citation: Lancet. 2010 Jul 3;376(9734):23-32
references.pmid: 20554319
references.citation: Lancet. 2007 Oct 20;370(9596):1453-7
references.pmid: 18064739
references.citation: PLoS Med. 2010 Mar 24;7(3):e1000251
references.pmid: 20352064
references.citation: N Engl J Med. 2008 May 29;358(22):2319-31
references.pmid: 18480196
references.citation: Crit Care. 2011;15(2):R92
references.pmid: 21392371