14-Day thawed plasma retains clot enhancing properties and inhibits tPA-induced fibrinolysis

Abstract

Background Plasma-first resuscitation attenuates trauma-induced-coagulopathy (TIC), however, the logistics of plasma-first resuscitation require thawed plasma (TP) be readily available due to the obligatory thawing time of FFP. The current standard is storage of TP for up to 5 days at 4°C, based on factor levels at outdate, for use in patients at risk for TIC, but there remains a 2.2% outdated wastage rate. However, the multitude of plasma proteins in attenuating TIC remain unknown. We hypothesize that TP retains the ability to enhance clotting and reduce tPA-induced fibrinolysis at 14 days storage. Methods FFP was thawed and stored at 4°C at the following intervals: 14, 10, 7, 5, 3, and 1-day prior to the experiment. Healthy volunteers underwent blood draws followed by 50% dilution with above TP stored intervals as well as FFP, normal saline (NS), albumin, and whole blood (WB) control. Samples underwent tPA-modified (75ng/ml) thrombelastography (TEG) with analysis of R-time, angle, maximum amplitude (MA), and LY30. Results TEG properties did not change significantly over the thawed storage. 14-day TP retained the ability to inhibit tPA-induced hyperfibrinolysis (median LY30% 9.6%) similar to FFP (5.6%), WB (14.6%) and superior to albumin (59.3%) and NS (58.1%). 14-day TP also retained faster clot formation (median angle, 66.2°) and superior clot strength (MA, 61.5mm) to albumin (34.8°, 21.6mm) and NS (41.6°, 32.2mm). Conclusion TP plasma stored for 14 days retains clot enhancing ability and resistance to clot degradation similar to FFP. A clinical trial is needed to validate these in vitro results.

28‐day thawed plasma maintains α2‐antiplasmin levels and inhibits tPA‐induced fibrinolysis

“…plasma [27]. There is an increased risk of hyperfibrinolysis in severely injured patients with each litre of pre‐hospital crystalloid, [18] which has been confirmed in vitro [3, 7, 10, 23]. The reported data reveal: a maintained time to clot initiation after dilution with saline or plasma; the angle (dynamics of clot formation) is enhanced in WB diluted with plasma ± tPA; and MA (cloth strength) and fibrinolysis (LY30) are maintained with TP dilutions compared to WB ± tPA.…”

“…Data shows that there is a 2·2% outdated wastage rate of plasma in the United States. This accounts for almost 130 000 units or wasted plasma each year at a cost of over $7 million [7]. Increasing the ability to store thawed plasma should reduce the wastage rate and further improve availability and accessibility to plasma in remote medical centres or austere environments.…”

“…We have previously described an in vitro assay combining whole blood with tPA to assess the impact of clot fibrinolysis with thrombelastography (TEG) for the evaluation of plasma resuscitation and fibrinolysis [3]. Furthermore, our group has evaluated the extended storage of up to 14 days of TP without changes in ability to inhibit tPA‐mediated fibrinolysis [7]. Extending the ability to utilize TP beyond 14 days may further improve availability and accessibility to TP in remote hospitals and austere environments.…”