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

• 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
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.15662

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.