Transfusion efficacy of novel anticoagulant‐preservative solution in a rat model of decompensated hemorrhagic shock

Background Hemorrhagic shock remains a leading cause of preventable death. Whole blood (WB) transfusion provides comprehensive resuscitation but is limited by storage‐related degradation under standard refrigerated citrate‐phosphate‐dextrose‐adenine (CPDA‐1) conditions. A novel additive solution (APEX) was designed to mitigate storage lesions and extend WB functionality. This study evaluated the hemostatic preservation and resuscitative efficacy of APEX‐stored WB in a rat model of decompensated hemorrhagic shock. Study Design and Methods WB was collected from anesthetized donor rats into CPDA‐1 or CPDA‐1 + APEX (7:5 ratio) and stored refrigerated (1–6°C) for 14 days. Recipient rats underwent a fixed‐volume (65% estimated blood volume) hemorrhage followed by resuscitation with stored WB. Physiologic recovery, hemostatic function (rotational thromboelastometry [ROTEM]), and metabolic parameters were assessed over 120 min post‐hemorrhage. Results APEX‐stored WB maintained comparable platelet and leukocyte counts and hemostatic indices to CPDA‐1 WB after 14 days. Rats resuscitated with APEX WB showed improved metabolic recovery over CPDA‐1, exhibiting significantly lower lactate ( p = .022) and higher glucose ( p = .021) levels at 120 min post‐hemorrhage. Coagulation parameters (obtained by ROTEM) remained near baseline in APEX‐treated animals, whereas CPDA‐1 WB induced a hypercoagulable, fibrinolytic profile. A modest increase in lung wet/dry ratio was observed in the APEX group, with no intestinal edema. Discussion In this preclinical model, we observed that APEX additive solution preserved rat WB quality and supported superior physiological recovery compared with standard CPDA‐1 storage. These pilot findings support further investigation of APEX as an alternative WB storage technology.