Excessive fibrinolysis detected with thromboelastography in a case of amniotic fluid embolism: fibrinolysis may precede coagulopathy

Amniotic fluid embolism (AFE) is a catastrophic condition in the peripartum period and still remains as a leading cause of maternal death. Although over 80% of cases of AFE cases are accompanied by coagulopathy, the pathology of disseminated intravascular coagulation is not well understood not only...

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Bibliographic Details
Published in:Journal of thrombosis and thrombolysis 2021-04, Vol.51 (3), p.818-820
Main Authors: Fudaba, M., Tachibana, D., Misugi, T., Nakano, A., Koyama, M.
Format: Article
Language:English
Subjects:
Adult
Amniotic fluid
Cardiology
Disseminated intravascular coagulation
Disseminated Intravascular Coagulation - blood
Disseminated Intravascular Coagulation - complications
Disseminated Intravascular Coagulation - diagnosis
Disseminated Intravascular Coagulation - etiology
Embolism
Embolism, Amniotic Fluid - blood
Embolism, Amniotic Fluid - diagnosis
Embolism, Amniotic Fluid - physiopathology
Embolisms
Emergency Medical Services - methods
Emergency Medical Services - organization & administration
Female
Fibrinolysis
Hematology
Hemorrhage
Humans
Hysterectomy - methods
Infant, Newborn
Medicine
Medicine & Public Health
Monitoring, Physiologic - methods
Obstetric Labor Complications - blood
Obstetric Labor Complications - diagnosis
Obstetric Labor Complications - physiopathology
Obstetric Labor Complications - therapy
Point-of-Care Testing - organization & administration
Postpartum
Postpartum Hemorrhage - etiology
Postpartum Hemorrhage - surgery
Pregnancy
Pregnancy Outcome
Thrombelastography - methods
Treatment Outcome
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Summary:Amniotic fluid embolism (AFE) is a catastrophic condition in the peripartum period and still remains as a leading cause of maternal death. Although over 80% of cases of AFE cases are accompanied by coagulopathy, the pathology of disseminated intravascular coagulation is not well understood not only because of its rarity but also because of the limited availability of laboratory testing in emergent clinical settings. We describe a case of AFE whose characteristic data for coagulation and fibrinolysis were timely depicted with sequential thromboelastography. We believe that the point-of-care, which provides information for both coagulopathy and fibrinolysis, may provide crucial data not only for the treatment of postpartum hemorrhage in daily clinical practice but also for the elucidation of AFE pathophysiology.
ISSN:0929-5305
1573-742X
1573-742X
DOI:10.1007/s11239-020-02237-x