Open Access

Emotional or evidence based medicine - is there a moral tragedy in haemostatic therapy?

  • Sibylle Kozek-Langenecker1Email author,
  • Benny Sørensen2, 3,
  • John Hess4 and
  • Donat R Spahn5
Critical Care201115:462

https://doi.org/10.1186/cc10583

Published: 29 December 2011

We strongly recommend that critical evaluation of medical practice is based on evidence rather than emotional reaction. Surprisingly, Stanworth and Hunt [1] seem to resort to the latter in response to our review [2]. Their questioning of ethics and morals appears unjustified, since we fully acknowledged multiple, serious limitations of the current evidence and methodologies within our review. They claim 'the danger of this review is that the message supports a move toward greater use of fibrinogen concentrate without proper evaluation' [1], ignoring our final statement that 'more high-quality, prospective studies are required before any definitive conclusions can be drawn' [2].

Proposing cryoprecipitate as an alternative source of fibrinogen is irrelevant in most European countries, where cryoprecipitate is not used due to safety concerns [3]. Cryoprecipitate is no longer regarded as appropriate therapy for hereditary bleeding disorders in Europe, the United States or the United Kingdom, and hence its administration for acquired coagulopathies represents a double standard [4].

Fibrinogen concentrate was first licensed in Brazil in 1963. Over 3 million grams have been used since 1985, mainly in countries where fibrinogen concentrate has approval for acquired bleeding. In Germany, Austria and Switzerland, fibrinogen concentrate represents the standard of care in most hospitals; it is typically used as the first-line haemostatic intervention. Restricting use of fibrinogen concentrate to clinical trials as suggested by Stanworth and Hunt seems absurd - consistent application of this principle would abolish the use of all blood-bank products.

If there is a moral tragedy, it is the acceptance of fresh frozen plasma and cryoprecipitate in practice despite the absence of evidence to confirm efficacy [3, 5].

Declarations

Authors’ Affiliations

(1)
Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna
(2)
Haemostasis Research Unit, Centre for Haemostasis and Thrombosis Guy's and St Thomas' Hospital & King's College London School of Medicine
(3)
Centre for Haemophilia and Thrombosis, Aarhus University Hospital
(4)
Department of Pathology, University of Maryland School of Medicine MSTF
(5)
Institute of Anaesthesiology, University Hospital Zurich

References

  1. Stanworth SJ, Hunt BJ: The desperate need for good-quality clinical trials to evaluate the optimal source and dose of fibrinogen in managing bleeding. Crit Care 2011, 15: 1006. 10.1186/cc10510PubMed CentralView ArticlePubMedGoogle Scholar
  2. Kozek-Langenecker S, Sørensen B, Hess J, Spahn DR: Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review. Crit Care 2011, 15: R239. 10.1186/cc10488PubMed CentralView ArticlePubMedGoogle Scholar
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  4. Bevan DH: Cardiac bypass haemostasis: putting blood through the mill. Br J Haematol 1999, 104: 208-219. 10.1046/j.1365-2141.1999.01182.xView ArticlePubMedGoogle Scholar
  5. Stanworth SJ, Brunskill SJ, Hyde CJ, McClelland DB, Murphy MF: Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol 2004, 126: 139-152. 10.1111/j.1365-2141.2004.04973.xView ArticlePubMedGoogle Scholar

Copyright

© BioMed Central Ltd 2011

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