Abstract Number: PB0479
Meeting: ISTH 2020 Congress
Background: Fibrinogen replacement is critical for hemorrhaging patients. Cryoprecipitate (cryo) and fibrinogen concentrates (FC) are sources of fibrinogen used clinically. Differences in their hemostatic effects are unclear.
Cryo contains additional proteins, including von Willebrand factor (vWF), FVIII, and FXIII, which may augment hemostasis. It is stored frozen and must be used within 6 hours of thaw, which limits clinical use due to logistical burden and waste.
Aims: The objective of this study was to examine the hemostatic rescue effects of cryo and FC in induced coagulopathies in a microfluidic model of hemorrhage.
Methods: The microfluidic model of hemorrhage comprised a native lumen and a tissue-factor- and collagen-coated injury space (Fig1A).
Healthy human donor whole blood (WB) was either diluted or tissue plasminogen activator (tPA)-treated to induce dilutional or fibrinolytic coagulopathy, respectively. Dosages were based on clinically-relevant targets (Fig1B). Coagulopathic blood was mixed with cryo (n=6) or FC (n=6) and perfused at an initial shear rate of 150, 500, or 5000 1/s. Cryo was tested on day 2 (d2), d5, d7 and d10 post-thaw. The FC dose was normalized to d0 cryo fibrinogen concentration (900 mg/dL). The primary endpoint was time to cessation of flow out of the lumen (bleeding time, BT).
Results: The mean BT of WB was 3.7 min at 150 1/s, 5.9 at 500, and 10.7 at 5000 (Fig1A). Coagulopathic blood did not clot within a maximum of 20 min at any shear rate (Fig1B). Cryo provided better rescue over FC for dilution (Fig1C), but there were no differences observed for fibrinolytic rescue (Fig1D). There was no loss in function of cryo out to 10 days post-thaw.
Conclusions: Cryo provides flow-dependent rescue of dilutional coagulopathy better than FC in a microfluidic model of hemorrhage. These differences occurred despite fibrinogen normalization. No loss in cryo function was observed up to 10 days post-thaw.
To cite this abstract in AMA style:Shea SM, Thomas KA, Spinella PC. Administration of Fibrinogen vs. Cryoprecipitate Stored out to 10 Days in Microfluidic Models of Coagulopathies in Hemorrhage [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/administration-of-fibrinogen-vs-cryoprecipitate-stored-out-to-10-days-in-microfluidic-models-of-coagulopathies-in-hemorrhage/. Accessed January 27, 2022.
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