Early And Systematic Administration Of Fibrinogen Concentrate In Postpartum Haemorrhage Following Vaginal Delivery: The Fidel Randomised Controlled Trial

Objective To assess the benefits and safety of early human fibrinogen concentrate in postpartum haemorrhage (PPH) management.Design Multicentre, double-blind, randomised placebo-controlled trial. Setting: 30 French hospitals.Population Patients with persistent PPH after vaginal delivery requiring a switch from oxytocin to prostaglandins.Methods Within 30 minutes after introduction of prostaglandins, patients received either 3 g fibrinogen concentrate or placebo.Main outcome measures Failure as composite primary efficacy endpoint: at least 4 g/dl of haemoglobin decrease and/or transfusion of at least two units of packed red blood cells within 48 hours following investigational medicinal product administration. Secondary endpoints: PPH evolution, need for haemostatic procedures and maternal morbidity-mortality within 6 +/- 2 weeks after delivery.Results 437 patients were included: 224 received FC and 213 placebo. At inclusion, blood loss (877 +/- 346 ml) and plasma fibrinogen (4.1 +/- 0.9 g/l) were similar in both groups (mean +/- SD). Failure rates were 40.0% and 42.4% in the fibrinogen and placebo groups, respectively (odds ratio [OR] = 0.99) after adjustment for centre and baseline plasma fibrinogen; (95% CI 0.66-1.47; P = 0.96). No significant differences in secondary efficacy outcomes were observed. The mean plasma FG was unchanged in the Fibrinogen group and decreased by 0.56 g/l in the placebo group. No thromboembolic or other relevant adverse effects were reported in the Fibrinogen group versus two in the placebo group.Conclusions As previous placebo-controlled studies findings, early and systematic administration of 3 g fibrinogen concentrate did not reduce blood loss, transfusion needs or postpartum anaemia, but did prevent plasma fibrinogen decrease without any subsequent thromboembolic events.Tweetable abstract Early systematic blind 3 g fibrinogen infusion in PPH did not reduce anaemia or transfusion rate, reduced hypofibrinogenaemia and was safe.