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. αantiplasmin 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.