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Blood. 2014 Sep 11;124(11):1727-36. doi: 10.1182/blood-2014-04-567891. Epub 2014 Jul 14.

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

Author information

1
Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom; Institute of Infection and Immunity, Critical Illness Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom;
2
Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
3
Institute of Translation, Innovation, Methodology and Engagement, South East Wales Trials Unit, Cardiff University School of Medicine, Cardiff, United Kingdom;
4
Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom;
5
Institute of Translation, Innovation, Methodology and Engagement, South East Wales Trials Unit, Cardiff University School of Medicine, Cardiff, United Kingdom; Department of Obstetrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
6
Department of Obstetrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
7
Institute of Infection and Immunity, Critical Illness Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom; Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
8
Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, United Kingdom; and.
9
Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom.

Abstract

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 <10 mm was associated with more prolonged bleeds (median [95% CI], 127 [44-210] compared with 65 [59-71] minutes; P = .018) and longer stay in the high-dependency unit (23.5 [18.4-28.5] compared with 10.8 [9.7-11.8] hours). Fibtem is a rapidly available early biomarker for progression of PPH.

Comment in

PMID:
25024304
DOI:
10.1182/blood-2014-04-567891
[Indexed for MEDLINE]
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