***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Essentials Perioperative bleeding  during prostate surgery is still a common morbidity . Anticoagulant and antiplatelet medications contribute to the risk of hemorrhage and prolonged hospital stay . Multiple pharmacological agents have been proposed , but none of them have been widely accepted . It is crucial to find a safe and effective modality to reduce hemorrhage . SUMMARY Background Hemorrhage during transurethral resection of the prostate ( TUR-P ) has always been a concern . Several studies have shown preoperative administration of fibrinogen concentrate to have promising results in reducing hemorrhage in cardiac surgery . Objectives To investigate the hemostatic effect of fibrinogen concentrate administration on reducing the amount of bleeding during TUR-P in patients with benign prostatic hyperplasia . Methods Sixty men with benign prostatic hyperplasia , who were chosen to undergo TUR-P , entered this prospect i ve r and omized double-blind placebo-controlled study . The participants were r and omly assigned to two groups : treatment ( n = 31 ) and placebo ( n = 29 ) . They received an infusion of 2 g of fibrinogen concentrate ( treatment group ) or normal saline ( placebo group ) before surgery . Data regarding the amount of bleeding , the operation and complications were recorded and analyzed . Results No difference was observed in bleeding between the fibrinogen and placebo groups during ( 521 mL versus 557 mL , respectively ) and after ( 291 mL versus 341 mL , respectively ) surgery . This lack of difference was also seen in operation time ( 43 min versus 42 min ) , irrigating fluid volume used during ( 17 L versus 19 L ) and after ( 29 L versus 28 L ) surgery , and resected adenoma volume ( 19 g versus 19 g ) . The mean blood pressure was also similar in both groups as a confounding factor for the amount of bleeding . Conclusion Preoperative administration of fibrinogen concentrate had no significant influence on intraoperative and postoperative bleeding in TUR-P surgery Background  Postoperative bleeding after heart operations is still a common finding , leading to allogeneic blood products transfusion . Fibrinogen and coagulation factors deficiency are possible determinants of bleeding . The experimental hypothesis of this study is that a first-line fibrinogen supplementation avoids the need for fresh frozen plasma ( FFP ) and reduces the need for any kind of transfusions . Methods and Results This was a single-center , prospect i ve , r and omized , placebo-controlled , double-blinded study . One-hundred sixteen patients undergoing heart surgery with an expected cardiopulmonary bypass duration > 90 minutes were admitted to the study . Patients in the treatment arm received fibrinogen concentrate after protamine administration ; patients in the control arm received saline solution . In case of ongoing bleeding , patients in the treatment arm could receive prothrombin complex concentrates ( PCCs ) and those in the control arm saline solution . The primary endpoint was avoidance of any allogeneic blood product . Patients in the treatment arm had a significantly lower rate of any allogeneic blood products transfusion ( odds ratio , 0.40 ; 95 % confidence interval , 0.19 to 0.84 , P=0.015 ) . The total amount of packed red cells and FFP units transfused was significantly lower in the treatment arm . Postoperative bleeding was significantly ( P=0.042 ) less in the treatment arm ( median , 300 mL ; interquartile range , 200 to 400 mL ) than in the control arm ( median , 355 mL ; interquartile range , 250 to 600 mL ) . Conclusions Fibrinogen concentrate limits postoperative bleeding after complex heart surgery , leading to a significant reduction in allogeneic blood products transfusions . No safety issues were raised . Clinical Trial Registration URL : http://www . clinical trials.gov . Unique identifier : NCT01471730 We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation . A r and omized , multicenter , hemoglobin‐stratified , double‐blind , fibrinogen‐versus‐saline – controlled trial was conducted . The primary end point was the percentage of patients requiring red blood cells . We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline ; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group . We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group . Nine patients in the saline group ( 20.9 % ) required  fibrinogen  at graft reperfusion ( compared with one patient [ 2.1 % ] in the fibrinogen group ; p = 0.005 ) . Blood was transfused to 52.9 % ( 95 % confidence interval [ CI ] 42.5–63.3 % ) in the fibrinogen group and 42.74 % ( 95 % CI 28.3–57.2 % ) in the saline group ( p = 0.217 ) . Relative risk for blood transfusion was 0.80 ( 95 % CI 0.57–1.13 ) . Thrombotic events occurred in one patient ( 2.1 % ) and five patients ( 11.4 % ) in the fibrinogen and saline groups , respectively . Seven patients ( 14.6 % ) in the fibrinogen group and nine ( 20.3 % ) in the saline group required reoperation . Preemptive administration of fibrinogen concentrate did not influence transfusion requirements BACKGROUND Low fibrinogen levels immediately after cardiac surgical procedures have been associated with postoperative bleeding and transfusions . However , no sound data on the adequate trigger values for fibrinogen supplementation and target values for fibrinogen concentration exist . METHODS This retrospective study examined prospect ively collected data , including data on 2,800 adult patients undergoing cardiac operations . St and ard coagulation parameters at the arrival in the intensive care unit were retrieved , inclusive of fibrinogen levels .  Postoperative bleeding was assessed based on the chest drain output ( mL/12 h ) . Severe bleeding ( SB ) was defined as chest drain output greater than 1,000 mL/12 h. RESULTS Postoperative blood loss was associated with low values of fibrinogen and platelet count , as well as with a prolonged activated partial thromboplastin time and international normalized ratio . At multivariable analysis , fibrinogen levels lower than 220 mg/dL remained independently associated with SB ( odds ratio : 2.25 ; 95 % confidence interval : 1.54 to 3.28 ) . A cutoff value of 115 mg/dL yielded a positive predictive value for SB of 50 % and may be proposed as a trigger value for fibrinogen supplementation , with a target value of 280 mg/dL ( 98 % negative predictive value for SB ) . In actively bleeding patients , these values are increased to 215 and 375 mg/dL , respectively . CONCLUSIONS These data confirm the independent role of fibrinogen levels as determinants of SB after cardiac surgical procedures and suggest adequate cutoff values and fibrinogen concentrate doses to prevent or treat SB . However , the identified trigger and target values should be confirmed in prospect i ve series of patients undergoing fibrinogen supplementation Background Surgery for benign disease is associated with a low-risk of developing venous thromboembolism ( VTE ) . Despite a relatively low incidence of postoperative VTE in patients after elective cholecystectomy and abdominal hernia repair there are data proving hypercoagulability in the early postoperative period . We focused on assessment of the systemic inflammatory response and coagulation status in these surgical patients after hospital discharge . Methods Prospect ively , patients who underwent surgery for benign disease were included . Two hundred sixteen patients were enrolled - 90 patients in laparoscopic cholecystectomy ( LC ) group and 126 patients in hernia surgery ( HS ) group .  Risk assessment of VTE according to the Caprini risk assessment model was performed in all patients . Prevalence of VTE in postoperative period was observed . Markers of systemic inflammatory response ( IL-6 , CRP , α-1-acid glycoprotein , transferrin ) and coagulation markers ( PLT , fibrinogen , prothrombin fragment F1 + 2 and D-dimer ) were measured before surgery , on 7–10th postoperative day and on 28–30th postoperative day . Results Clinical ly apparent deep vein thrombosis was diagnosed in only one patient - 0.46 % . Statistically significant elevation of inflammatory markers IL-6 , CRP and α-1-acid glycoprotein ( p < 0.001 ; all ) were proved in both groups of patients on 7–10th postoperative day . Statistically significant elevation of coagulation markers PLT , fibrinogen , prothrombin fragment F1 + 2 and D-dimer ( p < 0.001 ; all ) were proved in LC and HS groups on 7–10th postoperative day . No statistical difference was observed in IL-6 , CRP and α-1-acid glycoprotein levels a month after surgery as compared with preoperative levels within each group . Statistically significant elevation of fibrinogen and prothrombin fragment F1 + 2 levels ( p < 0.001 ; both ) persisted on 28–30th postoperative day in both groups . Persisted elevation of D-dimer levels was proved only in HS group ( p < 0.001 ) , not in LC group ( p = 0.138 ) , a month after surgery . Conclusions Activated systemic inflammatory response and hypercoagulable condition were verified in patients after laparoscopic cholecystectomy and hernia surgery after their hospital discharge . Hypercoagulability persisted even a month after surgery . Nevertheless , we observed very low prevalence of clinical ly apparent VTE in patients with in-hospital postoperative VTE prophylaxis . Trial registration Trials of the Czech Ministry of Health No. RVO-VFN64165 and NT 13251 - 4 BACKGROUND In early postpartum haemorrhage ( PPH ) , a low concentration of fibrinogen is associated with excessive subsequent bleeding and blood transfusion . We hypothesized that pre-emptive treatment with fibrinogen concentrate reduces the need for  red blood cell ( RBC ) transfusion in patients with PPH . METHODS In this investigator-initiated , multicentre , double-blinded , parallel r and omized controlled trial , we assigned subjects with severe PPH to a single dose of fibrinogen concentrate or placebo ( saline ) . A dose of 2 g or equivalent was given to all subjects independent of body weight and the fibrinogen concentration at inclusion . The primary outcome was  RBC transfusion  up to 6 weeks postpartum . Secondary outcomes were total blood loss , total amount of blood transfused , occurrence of rebleeding , haemoglobin < 58 g litre(-1 ) , RBC transfusion within 4 h , 24 h , and 7 days , and as a composite outcome of ' severe PPH ' , defined as a decrease in haemoglobin of > 40 g litre(-1 ) , transfusion of at least 4 units of RBCs , haemostatic intervention ( angiographic embolization , surgical arterial ligation , or hysterectomy ) , or maternal death . RESULTS Of the 249 r and omized subjects , 123 of 124 in the fibrinogen group and 121 of 125 in the placebo group were included in the intention-to-treat analysis . At inclusion the subjects had severe PPH , with a mean blood loss of 1459 ( sd 476 ) ml and a mean fibrinogen concentration of 4.5 ( sd 1.2 ) g litre(-1 ) . The intervention group received a mean dose of 26 mg kg(-1 ) fibrinogen concentrate , thereby significantly increasing fibrinogen concentration compared with placebo by 0.40 g litre(-1 ) ( 95 % confidence interval , 0.15 - 0.65 ; P=0.002 ) . Postpartum blood transfusion occurred in 25 ( 20 % ) of the fibrinogen group and 26 ( 22 % ) of the placebo group ( relative risk , 0.95 ; 95 % confidence interval , 0.58 - 1.54 ; P=0.88 ) . We found no difference in any predefined secondary outcomes , per- protocol analyses , or adjusted analyses . No thromboembolic events were detected . CONCLUSIONS We found no evidence for the use of 2 g fibrinogen concentrate as pre-emptive treatment for severe PPH in patients with normofibrinogenaemia . CLINICAL TRIAL REGISTRATION Clinical Trials.gov : http:// clinical trials.gov/show/NCT01359878 . Published protocol : http://www.trialsjournal.com/content/pdf/1745-6215-13-110.pdf Background : Fibrinogen is suggested to play an important role in managing major bleeding . However , clinical evidence regarding the effect of fibrinogen concentrate ( derived from human plasma ) on transfusion is limited . The authors assessed whether fibrinogen concentrate can reduce blood transfusion when given as intraoperative , targeted , first-line hemostatic therapy in bleeding patients 
    Output:
    
No significant differences were demonstrated in the adverse events associated with fibrinogen concentrate use , namely incidence of thromboembolism , myocardial infa rct ion and acute kidney injury .
CONCLUSIONS In this meta- analysis of 13 r and omized trials , low level of evidence and substantial heterogeneity with small sample size limit strong recommendation on the use of fibrinogen concentrate in adult surgical patients .
However , its use is tolerable without any notable adverse events .