PB1063 - In vitro fibrinogen concentrate supplementation in patients with end-stage liver disease improves functional clot quality

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Anna Tobiasch, MSc

Research Assistent
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria

Co-Author(s)

Johannes Bösch, MD

Resident physician, PhD student
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria
MT

Moritz Tobiasch

Senior physician
Tirol Kliniken Hall in Tirol, Department of Internal Medicine I
Hall in Tirol, Tirol, Austria
Mirjam Bachler, PhD

Senior Postdoc
University Hospital Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria
VS

Volker Schäfer

Specialist physician, Phd student
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria
PL

Philipp Lichtenberger

Resident physician
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria
MH

Martin Hermann

Postdoc
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria
HZ

Heinz Zoller

Senior physician
Medical University Innsbruck, Department of Internal Medicine I
Innsbruck, Tirol, Austria
DF

Dietmar Fries

Senior physician, Chief of Division
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine, Division of Critical Care Medicine
Innsbruck, Tirol, Austria

Background: Cirrhotic coagulopathy is a fragile equilibrium between pro- and anticoagulant mechanisms. The risk for intra- or post-procedual bleeding cannot be reliably assessed by standard coagulation tests. Viscoelastic tests help guide the administration of hemostatic products, but treatment thresholds have yet to be established. Large-volume blood products increase the risk for bleeding in end-stage liver disease (ESLD) patients, using factor concentrates might be a valuable option.

Aims: To describe the effect of fibrinogen supplementation on viscoelastic and standard coagulation parameters in whole blood from healthy volunteers and ESDL patients with < 150mg/dL fibrinogen.

Methods: After obtaining informed consent, 18 healthy volunteers and 17 hypofibrinogaemic patients with a Child-Turcotte-Pugh classification C (CTP-C) were recruited. Whole blood samples were spiked with 50, 100 and 200mg/dL fibrinogen concentrate (FC). Viscoelastic tests (EXtest, INtest, FIBtest, TPAtest), as well as activated partial thromboplastin time (aPTT), prothrombin time (PT) and thrombin time (TT) were assessed in both groups. Fibrinogen concentrations were determind by Clauss’ method and immunoassay. Fibrin networks were imaged with confocal microscopy.

Results: Spiking with FC resulted in a consistent increase of FIBtest mean clot firmness (MCF) in probands (R^2=0.89, p< 0.0001) and patients (R^2=0.93, p< 0.0001). Spiking whole blood of CTP-C patients with 200 mg/dL fibrinogen improved functional clot formation in all viscoelastic tests. Fibrinogen levels increased significantly (median 109 mg/dL vs. 274mg/dL, p< 0.0001), addition of 200mg/dL FC did not alter PT (mean difference +1.5%, p=0.6432), aPTT (mean difference+7.5sec, p=0.2678) or TT (median difference +1 sec, p=0.4625) compared to baseline in CTP-C patients.
Notably FIBtest MCF of CTP-C patients spiked with 50mg/dL FC matched levels derived from healthy volunteers (median 15mm vs. 14mm, p=0.5891).

Conclusion(s): Supplementation of fibrinogen in liver patients with end-stage liver disease is effective as evidenced by increased functional clot formation. Further studies are needed to determine the efficacy and safety of FC use.