Rotational thromboelastometry can identify low fibrinogen in postpartum hemorrhage: Study
UK: Rotational thromboelastometry (ROTEM Sigma) Fibtem A5 during postpartum hemorrhage (PPH) can detect fibrinogen 2g/L and guide targeted fibrinogen replacement, states a recent study. However, the researchers suggest that laboratory results should be continued to use for guiding platelet and fresh frozen plasma (FFP) transfusion. The study appears in the International Journal of Obstetric Anesthesia.
For the management of PPH, point-of-care viscoelastic hemostatic assays such as rotational thromboelastometry (including ROTEM and TEG) are being utilized. S.F. Bell, Department of Anaesthetics, Cardiff and Vale University Health Board, Cardiff, UK, and colleagues aimed to compare results obtained from the automated ROTEM Sigma with laboratory tests of coagulation and platelet count during PPH in a prospective observational study.
The study recruited women with PPH ≥1000 mL (or clinical concern of bleeding). The Fibtem A5, Extem CT and Pltem (Extem A5 – Fibtem A5) results were compared with laboratory tests of fibrinogen, activated partial thromboplastin time (APTT), prothrombin time (PT), and platelet count.
A total of 521 women were recruited, including 274/277 (98.9%) of women with PPH ≥1500 mL.
Salient findings of the study include:
- Fibtem A5 results were matched with laboratory fibrinogen in 552/644 (85.7%) samples.
- The incidence of abnormal laboratory results was low: fibrinogen ≤2 g/L 23/464 (5.0%), PT or APTT >1.5 × midpoint of reference range 4/464 (0.9%), and platelet count <75 × 109/L 11/477 (2.3%).
- Area-under-the-receiver operator characteristic curve for Fibtem A5 to detect fibrinogen ≤2 g/L was 0.96, with sensitivity and specificity of Fibtem A5 ≤11 mm to detect fibrinogen ≤2 g/L of 0.76 and 0.96.
- Prolonged Extem CT results improved after treatment of hypofibrinogenaemia alone.
- Intervention points for platelet and fresh frozen plasma (FFP) transfusion based on ROTEM Sigma parameters could not be established.
The researchers conclude, "during PPH (≥1000 mL or cases of clinical concern about bleeding), ROTEM Sigma Fibtem A5 can detect fibrinogen ≤2 g/L and guide targeted fibrinogen replacement." "Laboratory results should continue to be used to guide platelet and FFP transfusion."
"This study shows that the ROTEM Sigma is highly reliable in identifying fibrinogen levels that do not require treatment during PPH, enabling clinicians to avoid unnecessary empirical blood product administration," they wrote. Laboratory results should continue to be used to guide platelet and FFP transfusion, although if the Extem CT <75 s then coagulation factors are likely to be adequate, they explained.
Reference:
The study titled, "The sensitivity and specificity of rotational thromboelastometry (ROTEM) to detect coagulopathy during moderate and severe postpartum haemorrhage: a prospective observational study," was published in the International Journal of Obstetric Anesthesia.
