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. 2003;2003(2):CD004171.
doi: 10.1002/14651858.CD004171.

Fibrin sealant use for minimising peri-operative allogeneic blood transfusion

P A Carless  1 , D A Henry, D M Anthony
Affiliations

Fibrin sealant use for minimising peri-operative allogeneic blood transfusion

P A Carless et al. Cochrane Database Syst Rev. 2003.

Abstract

Background: Fibrin sealants have gained increasing popularity as interventions to improve peri-operative (intra/post-operative) haemostasis and diminish the need for allogeneic red cell transfusion (blood from an unrelated donor).

Objectives: To examine the efficacy of fibrin sealants in reducing peri-operative blood loss and allogeneic red blood cell (RBC) transfusion.

Search strategy: Studies were identified by: searches of MEDLINE, EMBASE, Current Contents, the Cochrane Library (July 2002), manufacturer web sites (to July 2002), and bibliographies of published articles.

Selection criteria: Controlled trials in which adult patients, scheduled for elective surgery, were randomised to fibrin sealant treatment or to a control group who did not receive fibrin sealant treatment. Trials were eligible if they reported data on the number of patients exposed to allogeneic red cell transfusion, the volume of blood transfused, or blood loss (assessed objectively).

Data collection and analysis: Primary outcomes measured were: the number of patients exposed to allogeneic red cells, the amount of blood transfused, and blood loss. Other outcomes measured were: re-operation due to bleeding, infection, mortality, and length of hospital stay. Treatment effects were pooled using a random effects model.

Main results: Seven trials, including a total of 388 patients, reported data on peri-operative exposure to allogeneic RBC transfusion. Fibrin sealant treatment, on average, reduced the rate of exposure to allogeneic red cell transfusion by a relative 54% (relative risk [RR] = 0.46: 95%CI = 0.32 to 0.68). Eight trials, including a total of 442 patients, provided data for post-operative blood loss. Fibrin sealant treatment reduced blood loss on average by around 134 per patient (95%CI = 51 to 217 ). However the trials reviewed were small and of poor methodological quality (91% unblinded).

Reviewer's conclusions: Overall the results suggest that fibrin sealants are efficacious in reducing both post-operative blood loss and peri-operative exposure to allogeneic RBC transfusion. However, due to the lack of blinding, transfusion practices may have been influenced by knowledge of the patient's treatment status. This raises concerns about the use of blood transfusion practice as an outcome variable in trials of fibrin sealant. In the case of blood loss, the results must be interpreted with caution, in view of the statistically significant heterogeneity in treatment effect observed. Large, methodologically rigorous, randomised controlled trials of fibrin sealants are needed.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgments about each methodological quality item for each included study.
3
3
4
4
1.1
1.1. Analysis
Comparison 1 Fibrin sealant versus control (blood transfusion), Outcome 1 No. exposed to allogeneic blood ‐ all studies.
1.2
1.2. Analysis
Comparison 1 Fibrin sealant versus control (blood transfusion), Outcome 2 No. exposed to allogeneic blood ‐ type of surgery.
1.3
1.3. Analysis
Comparison 1 Fibrin sealant versus control (blood transfusion), Outcome 3 No. exposed to allogeneic blood ‐ transfusion protocol.
1.4
1.4. Analysis
Comparison 1 Fibrin sealant versus control (blood transfusion), Outcome 4 No. exposed to allogeneic blood ‐ type of fibrin sealant.
1.5
1.5. Analysis
Comparison 1 Fibrin sealant versus control (blood transfusion), Outcome 5 No. exposed to allogeneic blood ‐ methodological quality.
1.6
1.6. Analysis
Comparison 1 Fibrin sealant versus control (blood transfusion), Outcome 6 Units of allogeneic blood transfused ‐ all studies.
2.1
2.1. Analysis
Comparison 2 Fibrin sealant versus control (blood loss), Outcome 1 Blood loss (total post‐operative) ‐ all studies.
2.2
2.2. Analysis
Comparison 2 Fibrin sealant versus control (blood loss), Outcome 2 Blood loss (total post‐operative) ‐ type of surgery.
2.3
2.3. Analysis
Comparison 2 Fibrin sealant versus control (blood loss), Outcome 3 Blood loss (total intra‐operative) ‐ all studies.
2.4
2.4. Analysis
Comparison 2 Fibrin sealant versus control (blood loss), Outcome 4 Blood loss (total intra‐operative) ‐ type of surgery.
2.5
2.5. Analysis
Comparison 2 Fibrin sealant versus control (blood loss), Outcome 5 Blood loss (total intra‐ + post‐operative) ‐ all studies.
3.1
3.1. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 1 Mortality.
3.2
3.2. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 2 Re‐operation for bleeding.
3.3
3.3. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 3 Infection ‐ any infection.
3.4
3.4. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 4 Infection ‐ wound infection.
3.5
3.5. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 5 Haematoma.
3.6
3.6. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 6 Stroke.
3.7
3.7. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 7 Deep vein thrombosis.
3.8
3.8. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 8 Pulmonary embolus.
3.9
3.9. Analysis
Comparison 3 Adverse events and other outcomes, Outcome 9 Length of hospital stay.
See this image and copyright information in PMC

References

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