The Efficacy of Fibrinogen Concentrates in Relation to Cryoprecipitate in Restoring Clot Integrity and Stability against Lysis

Loss of fibrinogen is a feature of trauma-induced coagulopathy (TIC), and restoring this clotting factor is protective against hemorrhages. We compared the efficacy of cryoprecipitate, and of the fibrinogen concentrates RiaSTAP(®) and FibCLOT(®) in restoring the clot integrity in models of TIC. Cryoprecipitate and FibCLOT(®) produced clots with higher maximal absorbance and enhanced resistance to lysis relative to RiaSTAP(®). The fibrin structure of clots, comprising cryoprecipitate and FibCLOT(®), mirrored those of normal plasma, whereas those with RiaSTAP(®) showed stunted fibers and reduced porosity. The hemodilution of whole blood reduced the maximum clot firmness (MCF) as assessed by thromboelastography. MCF could be restored with the inclusion of 1 mg/mL of fibrinogen, but only FibCLOT(®) was effective at stabilizing against lysis. The overall clot strength, measured using the Quantra(®) hemostasis analyzer, was restored with both fibrinogen concentrates but not cryoprecipitate. α(2)antiplasmin and plasminogen activator inhibitor-1 (PAI-1) were constituents of cryoprecipitate but were negligible in RiaSTAP(®) and FibCLOT(®). Interestingly, cryoprecipitate and FibCLOT(®) contained significantly higher factor XIII (FXIII) levels, approximately three-fold higher than RiaSTAP(®). Our data show that 1 mg/mL fibrinogen, a clinically achievable concentration, can restore adequate clot integrity. However, FibCLOT(®), which contained more FXIII, was superior in normalizing the clot structure and in stabilizing hemodiluted clots against mechanical and fibrinolytic degradation.