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Open AccessArticle

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

1
Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
2
Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
3
Oxford Haemophilia & Thrombosis Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
*
Author to whom correspondence should be addressed.
Academic Editor: Khaled Musallam
Int. J. Mol. Sci. 2021, 22(4), 2185; https://doi.org/10.3390/ijms22042185
Received: 25 January 2021 / Revised: 11 February 2021 / Accepted: 15 February 2021 / Published: 22 February 2021
(This article belongs to the Special Issue Fibrinogen/Fibrin, Factor XIII and Fibrinolysis in Diseases)
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. View Full-Text
Keywords: fibrinogen; cryoprecipitate; trauma coagulopathy; α2-antiplasmin; factor XIII fibrinogen; cryoprecipitate; trauma coagulopathy; α2-antiplasmin; factor XIII
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MDPI and ACS Style

Morrow, G.B.; Carlier, M.S.A.; Dasgupta, S.; Craigen, F.B.; Mutch, N.J.; Curry, N. Fibrinogen Replacement Therapy for Traumatic Coagulopathy: Does the Fibrinogen Source Matter? Int. J. Mol. Sci. 2021, 22, 2185. https://doi.org/10.3390/ijms22042185

AMA Style

Morrow GB, Carlier MSA, Dasgupta S, Craigen FB, Mutch NJ, Curry N. Fibrinogen Replacement Therapy for Traumatic Coagulopathy: Does the Fibrinogen Source Matter? International Journal of Molecular Sciences. 2021; 22(4):2185. https://doi.org/10.3390/ijms22042185

Chicago/Turabian Style

Morrow, Gael B.; Carlier, Molly S.A.; Dasgupta, Sruti; Craigen, Fiona B.; Mutch, Nicola J.; Curry, Nicola. 2021. "Fibrinogen Replacement Therapy for Traumatic Coagulopathy: Does the Fibrinogen Source Matter?" Int. J. Mol. Sci. 22, no. 4: 2185. https://doi.org/10.3390/ijms22042185

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