Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review.
Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review.
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与纤维蛋白原浓缩酸盐相比，新鲜冷冻血浆的临床有效性：系统评价。
DOI：
10.1186/cc10488
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Spahn DR
中科院分区：
文献类型：
--
作者：
Kozek-Langenecker S;Sørensen B;Hess JR;Spahn DR
手术和/或大面积创伤患者的止血治疗通常涉及新鲜冷冻血浆（FFP）的输注。在某些情况下，纯化的人纤维蛋白原浓缩物可作为FFP的替代品。在这篇系统性综述中，我们调查了在围手术期或大面积创伤环境中使用FFP和纤维蛋白原浓缩物的现有证据。在电子数据库（1995年至2010年）中确定了报告在围手术期或大面积创伤环境中给予患者FFP或纤维蛋白原浓缩物的结局（失血量、输血需求、住院时间、生存期和血浆纤维蛋白原水平）的研究。纳入的研究不考虑类型、患者年龄、样本量或患者随访持续时间。排除了先天性凝血因子缺乏或其他血液疾病患者的研究。评估研究的合格性，提取数据并制表。91项合格研究（70项FFP和21项纤维蛋白原浓缩物）报告了关注的结局。很少有高质量的前瞻性研究。所有评估结果中FFP疗效的证据不一致。总的来说，FFP对28%的结局有积极影响，对22%的结局有消极影响。FFP降低死亡率的证据有限：50%的结局与FFP降低死亡率（通常是创伤和/或大出血）相关，20%与死亡率增加相关（通常是手术和/或非大出血）。5项研究报告了纤维蛋白原浓缩物与对照品的结局。证据始终是积极的（所有结果的70%），没有报告负面影响（所有结果的0%）。在三项高质量研究中，纤维蛋白原浓缩物与FFP直接进行了比较，发现在减少失血量、同种异体输血需求、重症监护室和住院时间以及增加血浆纤维蛋白原水平方面，FFP在> 50%的结局方面具有上级优势。我们没有发现纤维蛋白原浓缩物在大面积创伤出血患者中的对照研究，尽管在许多非对照创伤研究中报告了所有评估结局的疗效。证据的权重似乎不支持FFP对手术和/或大面积创伤患者的临床有效性，并表明它可能是有害的。围手术期，纤维蛋白原浓缩物通常与改善的结局指标相关，尽管在得出任何明确的结论之前需要更多高质量的前瞻性研究。
Haemostatic 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. Studies 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. Ninety-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. The 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.
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影响因子：
1.9
作者：
Etemadrezaie, Hamid;Baharvahdat, Humain;Ganjeifar, Babak
通讯作者：
Ganjeifar, Babak
影响因子：
2.3
作者：
Antolovic, Dalibor;Koch, Moritz;Weitz, Juergen
通讯作者：
Weitz, Juergen
DOI：
10.1536/jhj.43.151
发表时间：
2002-03-01
期刊：
JAPANESE HEART JOURNAL
影响因子：
--
作者：
Apaydin, AZ;Posacioglu, H;Durmaz, I
通讯作者：
Durmaz, I
DOI：
10.1097/ta.0b013e3181cf7f2a
发表时间：
2010-02-01
影响因子：
--
作者：
Dente, Christopher J.;Shaz, Beth H.;Ingram, Walter L.
通讯作者：
Ingram, Walter L.
影响因子：
2.7
作者：
Demeyere, R.;Gillardin, S.;Strengers, P. F. W.
通讯作者：
Strengers, P. F. W.