There May Not Be a Definite Winner, But Fibrinogen Concentrate is Clearly a Factor to Be Reckoned With

2021 ◽  
Vol 133 (1) ◽  
pp. 16-18
Author(s):  
John S. McNeil ◽  
Jacob Raphael
Keyword(s):  
Fibrinogen Concentrate

scholarly journals Fibrinogen Replacement Therapy for Traumatic Coagulopathy: Does the Fibrinogen Source Matter?

2021 ◽  
Vol 22 (4) ◽  
pp. 2185
Author(s):  
Gael B. Morrow ◽  
Molly S. A. Carlier ◽  
Sruti Dasgupta ◽  
Fiona B. Craigen ◽  
Nicola J. Mutch ◽  
...  
Keyword(s):  
Coagulation Factors ◽  
Clot Lysis ◽  
Strongly Correlated ◽  
Good Recovery ◽  
Fibrinogen Concentrate ◽  
Clot Strength ◽  
Coagulation Protein ◽  
Low Levels ◽  
Fibrinogen Replacement Therapy ◽  
Traumatic Coagulopathy

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. Fibrinogen 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 cryoprecipitate may be a superior source of fibrinogen to successfully control bleeding in trauma coagulopathy. However, these different products require evaluation in a clinical setting.

Fibrinogen depletion after plasma-dilution: impairment of proteolytic resistance and reversal via clotting factor concentrates

2014 ◽  
Vol 111 (03) ◽  
pp. 417-428 ◽  
Author(s):  
Hans Johnsson ◽  
Michal Zabczyk ◽  
Kjell Hultenby ◽  
Håkan Wallen ◽  
Margareta Blombäck ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Clotting Factor ◽  
Clot Lysis ◽  
Trauma Patients ◽  
Fibrinogen Concentrate ◽  
Reversal Effect ◽  
Proteolytic Resistance ◽  
Small Doses ◽  
Fibrinolysis Inhibitor

SummaryIn trauma patients, resuscitation treatment of intravascular volume may cause haemodilution including blood cell- and plasma-dilution. After plasma-dilution, fibrinogen is the first factor that decreases to critically low concentrations. Fibrin formed in lowered levels is susceptible to fibrinolysis, a natural forerunner for bleeding. To assess whether a fibrinogen concentrate or a factor XIII (FXIII) concentrate can reverse the impairment of fibrin properties after plasma dilution, different laboratory methods were used to determine thrombin generation and fibrin quantity/quality in a normal plasma sample diluted in vitro. Coagulation and clot lysis by plasmin were triggered with tissue factor and rt-PA, respectively. We found that while the endogenous thrombin potential (ETP) was unaffected after plasma-dilution due to postponement of thrombin decay, levels of fibrinogen and hence fibrin were decreased in dilution degree-dependency. The imbalance between influence of the dilution on thrombin activity and fibrin formation brought unexpected outcomes of fibrin properties: the formed clots favoured the degradation by plasmin but the fibrin networks remained tighter/less permeable. This proteolytic tendency was partly overturned by the fibrinogen concentrate added (total fibrinogen ≥ 2 g/l), and much more affected if used in combination with tranexamic acid (a fibrinolysis inhibitor) at small doses. No reversal effect resulted from the FXIII concentrate added. We conclude that plasma-dilution did reduce the proteolytic resistance of formed clots. The fibrinogen concentrate, better together with small doses of tranexamic acid, may reverse the impairment of fibrin property. The FXIII concentrate is not effective in this regard in our in vitro model using platelet-poor plasma.

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