Fibrinogen concentrations rise rapidly during severe bleeding caused by trauma before any other coagulation proteins. Plasma samples from the Fibrinogen Early in Severe Trauma studY (FEISTY; NCT02745041) were compared before and after adding fibrinogen in a controlled laboratory setting. Cryoprecipitate (cryo) and fibrinogen concentrate (Fg-C; Riastap) are 2 blood products that can be used to treat trauma victims, but FEISTY is the first randomized controlled experiment to assess how long it takes to administer each directly. Clot strength and fibrinolytic stability will be evaluated in this study to identify individual and group differences. Plasma from FEISTY patients was analyzed by clot lysis, plasmin production, atomic force microscopy, and confocal microscopy to determine clot strength and structure. After the transfusion, there was a marked rise in fibrinogen levels in both groups. Following a transfusion of cryo, the rate of plasmin production was decreased by a factor of 1.5, but transfusion with Fg-C had no effect. After cryo treatment, plasminogen activator inhibitor 1 activity and Factor XIII antigen were elevated, whereas Fg-C had no effect. By analyzing fibrin clots with confocal microscopy, researchers found that cryo transfusion effectively revived clot structure to that of control samples. However, Fg-C infusion did not improve clot quality, which remained porous with stunted fibers. Treatment with cryo enhanced the toughness and stiffness of individual fibers, while treatment with Fg-C did not. In conclusion,f an ex vivo laboratory, investigation results show that cryo transfusion restores critical fibrinolytic regulators and restricts plasmin production, resulting in stronger clots. The results of this first-of-its-kind study show that cryo’s extra components allow for the creation of a stronger and more stable clot than those of Fg-C.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04167-x