To systemically explore the efficacy and safety of fibrinogen (FG) in the treatment of trauma-induced coagulopathy (TIC).

PubMed, EMBASE, the Cochrane Library, CBM, CNKI, Wanfang and VIP databases were searched to collect randomized controlled trials (RCTs) about FG in the treatment of TIC published up to April 2023. The control group was given conventional treatment such as packed red blood cell (PRBC), fresh frozen plasma (FFP), tranexamic acid and active rehydration, while the experimental group was given intravenous infusion of human FG concentrate based on the control group. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then the meta-analysis was performed using RevMan 5.4 software.

A total of nine RCTs involving 568 patients were included. The meta-analysis showed that the transfusion of PRBC [standard mean difference (SMD) = -0.98, 95% confidence interval (CI) (-1.89, -0.07), Z = 2.10, P = 0.04] and FFP [SMD = -1.69, 95%CI (-3.18, -0.21), Z = 2.23, P = 0.03] was much lower, and the length of stay in hospital [SMD = -0.84, 95%CI (-1.15, -0.52), Z = 5.22, P < 0.000 01] and ICU [SMD = -0.71, 95%CI (-1.01, -0.40), Z = 4.59, P < 0.000 01] was much shorter in the experimental group than in the control group. However, there were no significant differences in the mortality [risk ratio (RR) = 0.63, 95%CI (0.29, 1.38), Z = 1.15, P = 0.25] and rate of embolization events [RR = 1.35, 95%CI (0.53, 3.40), Z = 0.63, P = 0.53] between the two groups.

Supplementation of FG cannot reduce the mortality of TIC patients, but can decrease the need for transfusion and shorten the duration in hospital.