Comparison of Two Different Fibrinogen Concentrates in an in vitro Model of Dilutional Coagulopathy

Authors: Groene, P., Wiederkehr, T., Kammerer, T., Mohnle, P., Maerte, M., Bayer, A., Gorlinger, K., Rehm, M., and Schafer, S. T.

Publication: Transfus Med Hemother.; 47,2:167-174. May 2020

Affiliations: Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany; Institute for Anaesthesiology and Pain Therapy, HDZ NRW, Bad Oeynhausen, Germany; Medical Director, TEM Innovations, Munich, Germany.

Abstract: INTRODUCTION: Fibrinogen concentrates are widely used to restore clot stability in situations of bleeding. Fibrinogen preparations are produced using different production methods, resulting in different compounds. Thus, different preparations might have a distinct impact on blood coagulation. We tested the effect of fibrinogen concentrates Haemocomplettan(R) (CSL Behring, Marburg, Germany) and fibryga(R) (Octapharma GmbH, Langenfeld, Germany) on the impairments induced by 60% dilutional coagulopathy in vitro. Materials and Methods: The influence of the fibrinogen concentrates fibryga(R) and Haemocomplettan(R) on colloid (gelatine, hydroxyethyl starch [HES], albumin)-induced or crystalloid (Ringer’s acetate)-induced dilutional coagulopathy was analysed using rotational thromboelastometry (ROTEM(R)) and standard laboratory tests. The following experimental conditions were analysed in vitro: whole blood, 60% dilution (40% blood and 60% diluent) +/- 50 or 100 mg/kg^-1 fibryga(R) or Haemocomplettan(R), respectively. RESULTS: Dilution with either diluent resulted in prolonged clotting time (CT) in an extrinsic activated test (CT_EXTEM) and decreased maximum clot firmness (MCF_FIBTEM) as expressed, e.g., by gelatine: (59.5 s [62/54.8] vs. 95 s [102.8/86.8]; p < 0.001 and 14 mm [16/10.5] vs. 3 mm [4-3]; p < 0.001). Substitution after 60% dilution with HES resulted in no difference between the preparations, except for shorter thrombin time with fibryga(R) (14 s [15/14] vs. 18 s [18.8/17]; p = 0.0093; low dose). CT_EXTEM was higher with Haemocomplettan(R) in a gelatine-induced dilution (51 s [54.5/47.5] vs. 63 s [71/60.3]; p = 0.0202; low dose) whereas thrombin time was lower with fibryga(R) (19.5 s [20.8/19] vs. 27 s [29/25.3]; p = 0.0017). In dilution with albumin, differences in CT_EXTEM (69 s [76.5/66] vs. 56 s [57/53.3]; p = 0.0114; low dose) and thrombin time (18 s [18/17] vs. 24.5 s [25.8/24]; p = 0.0202; low dose) were seen. In dilution with crystalloid solution, again differences in CT_EXTEM (53.5 s [57.8/53] vs. 45 s [47/43]; p = 0.035; low dose) and thrombin time (17 s [17/16] vs. 23.5 s [24/23]; p = 0.0014; low dose) were seen. Fibrinogen levels were more increased by high-dose substitution of both preparations. CONCLUSION: Based on this data it can be stated that both fibryga(R) and Haemocomplettan(R) had the same performance in our in vitro model except for CT_EXTEM and thrombin time.