Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial
Peter William Collins,Rebecca Cannings-John,Daniel Bruynseels,Shuba Mallaiah,J. Dick,C. Elton,Andrew Weeks,Julia Sanders,Nadine Aawar,Julia Townson,Kerenza Hood,Judith Elizabeth Hall,R. E. Collis +12 more
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TLDR
Pre-specified subgroup analyses suggest that fibrinogen replacement is not required if the Fibtem A5 is > 12 mm or Clauss fibr inogen >2 g litre -1, but an effect below these levels cannot be excluded, and the raised fibrInogen at term appears to be a physiological buffer rather than required for haemostasis.Abstract:
Background: Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. We hypothesized that early fibrinogen replacement, guided by viscoelastometric testing, reduces blood product usage and bleed size. Methods: Women with PPH 1000–1500 ml were enrolled. If Fibtem A5 was ≤15 mm and bleeding continued, subjects were randomized to fibrinogen concentrate or placebo. The primary outcome compared the number of units of red blood cells, plasma, cryoprecipitate and platelets transfused. Results: Of 663 women enrolled 55 were randomized. The adjusted incidence rate ratio (IRR) (95% CI) for the number of allogeneic units transfused in the fibrinogen group compared with placebo was 0.72 (0.3–1.7), P=0.45. In pre-specified subgroup analyses, subjects who had a Fibtem A5 ≤12 mm at the time of randomization and who received fibrinogen concentrate received a median (25th–75th centile) of 1 (0–4.5) unit of allogeneic blood products and had an additional 300 (100–350) ml blood loss whereas those who received placebo also received 3 (0–6) units of allogeneic blood products and had 700 (200–1550) ml additional blood loss; these differences were not statistically significantly different. There was one thrombotic event in each group. Conclusions: Infusion of fibrinogen concentrate triggered by Fibtem A5 ≤15 mm did not improve outcomes in PPH. Pre-specified subgroup analyses suggest that fibrinogen replacement is not required if the Fibtem A5 is > 12 mm or Clauss fibrinogen >2 g litre−1, but an effect below these levels cannot be excluded. The raised fibrinogen at term appears to be a physiological buffer rather than required for haemostasisread more
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Iconographies supplémentaires de l'article : Incidence, risk factors, and temporal trends in severe postpartum hemorrhage
Michael S. Kramer,Cynthia J. Berg,Haim A. Abenhaim,Mourad Dahhou,Jocelyn Rouleau,Azar Mehrabadi,K.S. Joseph +6 more
TL;DR: In this paper, the authors examined temporal trends in severe postpartum hemorrhage, defined as PPH plus receipt of a blood transfusion, hysterectomy, and/or surgical repair of the uterus.
Journal ArticleDOI
The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline.
Nicola Curry,Ross Davenport,Sue Pavord,Susan Mallett,Dianne P. Kitchen,Andrew A. Klein,Helena Maybury,Peter William Collins,Michael Laffan +8 more
TL;DR: This research presents a meta-analysis of 120 cases of sepsis in eight London hospitals over a 12-month period in the period of May 21 to 29, 2013 of Haematology and concludes with a call for further studies into the causes and treatments of septicaemia.
Journal ArticleDOI
The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management
Klaus Görlinger,A. Perez-Ferrer,Daniel Dirkmann,Fuat H. Saner,Marc Maegele,Ángel Augusto Pérez Calatayud,Tae-Yop Kim +6 more
TL;DR: ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety, but the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.
Journal ArticleDOI
Four years' experience of a ROTEM® -guided algorithm for treatment of coagulopathy in obstetric haemorrhage.
TL;DR: Analysis of rotational thromboelastometry results demonstrated that coagulopathy is not observed in all women who suffer obstetric haemorrhage and cannot be predicted solely by blood loss, and formulaic treatment with blood products is not justified.
Journal ArticleDOI
Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH.
TL;DR: Variability between study protocols and results suggests the need for future large prospective high‐quality studies with standardized protocols to investigate the utility of TEG/ROTEM in assessing risk for thrombosis and hemorrhage as well as in guiding prophylaxis and treatment in obstetric patients.
References
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TL;DR: Findings indicate that a simple fibrinogen measurement can anticipate the risk of severe bleeding in PPH.
Journal ArticleDOI
Incidence, risk factors, and temporal trends in severe postpartum hemorrhage
Michael S. Kramer,Cynthia J. Berg,Haim A. Abenhaim,Mourad Dahhou,Jocelyn Rouleau,Azar Mehrabadi,K.S. Joseph +6 more
TL;DR: A doubling in incidence of severe PPH over 10 years was not explained by contemporaneous changes in studied risk factors, as well as changes in risk factors themselves.
Iconographies supplémentaires de l'article : Incidence, risk factors, and temporal trends in severe postpartum hemorrhage
Michael S. Kramer,Cynthia J. Berg,Haim A. Abenhaim,Mourad Dahhou,Jocelyn Rouleau,Azar Mehrabadi,K.S. Joseph +6 more
TL;DR: In this paper, the authors examined temporal trends in severe postpartum hemorrhage, defined as PPH plus receipt of a blood transfusion, hysterectomy, and/or surgical repair of the uterus.
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Haemostatic reference intervals in pregnancy
TL;DR: The level of coagulation factors II, V, X, XI, XII and antithrombin, protein C, aPTT, PT remained largely unchanged during pregnancy, delivery, and postpartum and were within non-pregnant reference intervals, however, levels of fibrinogen, D-dimer, and coagulations VII, VIII, and IX increased markedly.
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