Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study

This prospective, observational study investigated the utility of Fibtem A5 and Clauss fibrinogen as predictors of progression of postpartum hemorrhage (PPH). A consecutive cohort of 356 women experiencing 1000 to 1500 mL PPH was recruited. Fibtem and fibrinogen were measured and subsequent transfus...

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Bibliographic Details
Published in:Blood 2014-09, Vol.124 (11), p.1727-1736
Main Authors: Collins, Peter W., Lilley, Graeme, Bruynseels, Daniel, Laurent, David Burkett-St, Cannings-John, Rebecca, Precious, Elizabeth, Hamlyn, Vincent, Sanders, Julia, Alikhan, Raza, Rayment, Rachel, Rees, Alexandra, Kaye, Abigail, Hall, Judith E., Paranjothy, Shantini, Weeks, Andrew, Collis, Rachel E.
Format: Article
Language:English
Subjects:
Adult
Biomarkers - blood
Blood Coagulation
Erythrocyte Transfusion
Female
Fibrin - metabolism
Humans
Postpartum Hemorrhage - blood
Postpartum Hemorrhage - therapy
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Summary:This prospective, observational study investigated the utility of Fibtem A5 and Clauss fibrinogen as predictors of progression of postpartum hemorrhage (PPH). A consecutive cohort of 356 women experiencing 1000 to 1500 mL PPH was recruited. Fibtem and fibrinogen were measured and subsequent transfusions, invasive procedures, and bleed volume recorded. Women progressing to 8 U blood products (red blood cells [RBCs] + fresh frozen plasma [FFP] + platelets) had a median (interquartile range) fibrinogen and Fibtem A5 of 2.1 (1.8-3.4) g/L and 12 (7-17) mm, respectively, compared with 3.9 (3.2-4.5) and 19 (17-23) for those not progressing. On multivariate analysis, Fibtem was an independent predictor for progression to bleeds >2500 mL (95% confidence interval [CI], 0.85 [0.77-0.95]). Receiver operating characteristic area under the curve (95% CI) for progression to RBC transfusion was 0.67 (0.60-0.74) for fibrinogen and 0.61 (0.54-0.68) for Fibtem, and progression to >2500 mL was 0.71 (0.61-0.81) and 0.75 (0.66-0.85) for fibrinogen and Fibtem, respectively. Fibtem A5 2500 mL, duration of bleed, and time in high dependency.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2014-04-567891