Viscoelastic haemostatic point‐of‐care assays in the management of postpartum haemorrhage: a narrative review

Summary Viscoelastic haemostatic assays provide rapid testing at the bed‐side that identify all phases of haemostasis, from initial fibrin formation to clot lysis. In obstetric patients, altered haemostasis is common as pregnancy is associated with coagulation changes that may contribute to bleeding...

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Bibliographic Details
Published in:Anaesthesia 2022-06, Vol.77 (6), p.700-711
Main Authors: Dias, J. D., Butwick, A. J., Hartmann, J., Waters, J. H.
Format: Article
Language:English
Subjects:
Algorithms
Assaying
Bioassays
Blood Coagulation Disorders - therapy
Coagulation
coagulopathy
Female
Fibrin
Fibrinolysis
Hemorrhage
Hemostasis
Hemostatics - therapeutic use
Humans
Lysis
Obstetrics
Patients
Point of care testing
Point-of-Care Systems
Postpartum
postpartum haemorrhage
Postpartum Hemorrhage - drug therapy
Postpartum Hemorrhage - therapy
Postpartum period
Pregnancy
Thrombelastography
thromboelastography
thromboelastometry
Thromboembolism
Thrombosis
Transfusion
Viscoelasticity
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Summary:Summary Viscoelastic haemostatic assays provide rapid testing at the bed‐side that identify all phases of haemostasis, from initial fibrin formation to clot lysis. In obstetric patients, altered haemostasis is common as pregnancy is associated with coagulation changes that may contribute to bleeding events such as postpartum haemorrhage, as well as thrombosis events. In this narrative review, we examine the potential clinical utility of viscoelastic haemostatic assays in postpartum haemorrhage and consider the current recommendations for their use in obstetric patients. We discuss the clinical benefits associated with the use of viscoelastic haemostatic assays due to the provision of (near) real‐time readouts with a short turnaround, coupled with the identification of coagulation defects such as hypofibrinogenaemia. The use of viscoelastic haemostatic assay‐guided algorithms may be beneficial to diagnose coagulopathy, predict postpartum haemorrhage, reduce transfusion requirements and monitor fibrinolysis in women with obstetric haemorrhage. Further studies are required to assess whether viscoelastic haemostatic assay‐guided treatment improves clinical outcomes, and to confirm the utility of prepartum viscoelastic haemostatic assay measurements for identifying patients at risk of postpartum haemorrhage.
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.15662