The efficacy of fibrin sealant in knee surgery: A meta-analysis

Abstract Background Fibrin sealant is frequently used in knee surgery as an adjuvant method for reducing postoperative bleeding, however, there is no consensus regarding the efficacy of fibrin sealant. Hypothesis Fibrin sealant achieves better efficacy in terms of blood loss control, transfusion rate and units in knee surgery compared with controls. Methods A search of the Cochrane Collaboration (2013 Issue 09), Embase (1974–2013.09), PubMed (1966–2013.09) and Chinese databases (up to 2013.09) were conducted. The Cochrane Collaboration's tool was used to assess for bias and data were analyzed by RevMan 5.29 software. Results This study included nine RCTs and four prospective comparative trials with a total of 1299 patients. Compared to the control, fibrin sealant achieved a decrease in hemoglobin reduction [MD = 1.14, 95% CI (0.61–1.67)], transfusion rate [OR = 0.36, 95% CI (0.25–0.51)], transfusion units [MD = 0.47, 95% CI (0.24–0.71)], hospital stay [MD = 2.22, 95% CI (0.56–3.88)] and the incidence of complications [OR = 0.56, 95% CI (0.38–0.83)]. And it also reduced total blood loss, while there was no significant difference [MD = 155.83, 95% CI (–525.02–213.15)]. Conclusion Patients undergoing knee surgery would benefit from high-dose fibrin sealant with reduced transfusion rate and unit, hospital stay and complications, while they might benefit little from it in total blood loss. However, the effects of a low-dose of fibrin in knee surgery remain inconclusive. Level of evidence Level III.