Fibrinogen replacement therapy for traumatic coagulopathy: does the fibrinogen source matter?

Morrow, Gael B.; Carlier, Molly S.A.; Dasgupta, Sruti; Craigen, Fiona B.; Mutch, Nicola J.; Curry, Nicola

Abstract

Fibrinogen is the first coagulation protein to reach critically low levels during traumatic haemorrhage. There have been no differential effects on clinical outcomes between the two main sources of fibrinogen replacement: cryoprecipitate and fibrinogen concentrate (Fg‐C). However, the constituents of these sources are very different. The aim of this study was to determine whether these give rise to any differences in clot stability that may occur during trauma haemorrhage. Fi-brinogen deficient plasma (FDP) was spiked with fibrinogen from cryoprecipitate or Fg‐C. A panel of coagulation factors, rotational thromboelastography (ROTEM), thrombin generation (TG), clot lysis and confocal microscopy were performed to measure clot strength and stability. Increasing concentrations of fibrinogen from Fg‐C or cryoprecipitate added to FDP strongly correlated with Clauss fibrinogen, demonstrating good recovery of fibrinogen (r2 = 0.99). A marked increase in Factor VIII, XIII and α2‐antiplasmin was observed in cryoprecipitate (p < 0.05). Increasing concentrations of fibrinogen from both sources were strongly correlated with ROTEM parameters (r2 = 0.78– 0.98). Cryoprecipitate therapy improved TG potential, increased fibrinolytic resistance and formed more homogeneous fibrin clots, compared to Fg‐C. In summary, our data indicate that cryoprecip-itate may be a superior source of fibrinogen to successfully control bleeding in trauma coagulopa-thy. However, these different products require evaluation in a clinical setting.

Citation

MORROW, G.B., CARLIER, M.S.A., DASGUPTA, S., CRAIGEN, F.B., MUTCH, M.J. and CURRY, N. 2021. Fibrinogen replacement therapy for traumatic coagulopathy: does the fibrinogen source matter? International journal of molecular sciences [online], 22(4), article 2185. Available from: https://doi.org/10.3390/ijms22042185

• Journal Article Type: Article
• Acceptance Date: Feb 15, 2021
• Online Publication Date: Feb 22, 2021
• Publication Date: Feb 28, 2021
• Deposit Date: Aug 7, 2023
• Publicly Available Date: Aug 14, 2023
• Journal: International journal of molecular sciences
• Print ISSN: 1661-6596
• Electronic ISSN: 1422-0067
• Publisher: MDPI
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Issue: 4
• Article Number: 2185
• DOI: https://doi.org/10.3390/ijms22042185
• Keywords: Fibrinogen cryoprecipitate; Trauma coagulopathy; α2-antiplasmin; Factor XIII
• Public URL: https://rgu-repository.worktribe.com/output/2034947