Abstract Number: OC 42.4
Meeting: ISTH 2021 Congress
Background: Fibrinogen is the first coagulation protein to reach critically low levels during traumatic haemorrhage. The Fibrinogen Early in Severe Trauma studY (FEISTY; NCT02745041) is the first randomised controlled trial to compare the effects of cryoprecipitate and fibrinogen concentrate (Fg-C), which are comprised of very different constituents.
Aims: To compare the efficacy of Fg-C or cryoprecipitate as a source of fibrinogen in traumatic haemorrhage and establish the more favourable treatment option in these patients.
Methods: A panel of coagulation factors were measured in cryoprecipitate and Fg-C using a Siemens Sysmex CS-5100 haematology analyser. Plasmin generation was performed on plasma samples obtained from the FEISTY trial. Further in vitro analysis was performed using fibrinogen deficient plasma (FDP) spiked with fibrinogen from cryoprecipitate or Fg-C, and thrombin generation (TG), clot lysis and confocal microscopy performed.
Results: A marked increase in FVIII (190-fold), FXIII (107-fold) and a2-antiplasmin (98-fold) was observed in cryoprecipitate, compared to Fg-C (p <0.05). Plasmin generation was significantly reduced in trauma patients treated with cryoprecipitate, but remained unchanged in those treated with Fg-C. This was observed as a 1.5-fold decrease in the rate of plasmin generation pre- and post-transfusion of cryoprecipitate (p <0.01). FDP spiked with increasing concentrations of cryoprecipitate, but not Fg-C, significantly improved TG potential (p <0.05) and prolonged the clot lysis time (p <0.001). Fibrin clots formed with cryoprecipitate revealed a fibrin structure comparable to that of normal plasma. In contrast, clots formed with Fg-C demonstrated a heterogenous structure with evidence of stunted protofibril formation.
Conclusions: The rate of plasmin generation is attenuated following cryoprecipitate transfusion, but is not altered in the Fg-C cohort. This suggests that the rate of fibrinolysis is different following transfusion of these two products. Our data indicate that cryoprecipitate may be a superior source of fibrinogen to manage bleeding in trauma coagulopathy.
To cite this abstract in AMA style:B Morrow G, SA Carlier M, Dasgupta S, B Craigen F, S Whyte C, Winearls J, A Laffan M, J Mutch N, Curry N. Cryoprecipitate Transfusion Significantly Decreases the Rate of Plasmin Generation in Trauma Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/cryoprecipitate-transfusion-significantly-decreases-the-rate-of-plasmin-generation-in-trauma-patients/. Accessed December 11, 2023.
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