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

Abstract

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

Changes of Coagulation and Fibrinolytic Status Detected by Thromboelastography (TEG6s®) in Pregnancy, Labor, Early Postpartum, Postpartum Hemorrhage and Heparin Treatment for Perinatal Venous Thrombosis

“…), and that we did not assess thromboelastographic parameters in cases with placental abruption or amniotic fluid embolism, where life-threatening coagulopathy rapidly occurs. Furthermore, thromboelastography may be less sensitive to fibrinolysis, except in conditions of excessive hyperfibrinolysis [ 17 , 34 , 35 ]. We also did not show the superiority of thromboelastography to APTT for monitoring the effect of heparin in cases with thrombus.…”

“…DVT and PE are raised as leading causes of pregnancy-related deaths, and in cases where unstable and/or newly developed DVT and/or PE are recognized, immediate anticoagulant therapy should be started and continued just before the initiation of delivery [ 13 , 14 ]. Furthermore, amniotic fluid embolism, which is relatively rare but characterized by excessive fibrinolysis and resulting catastrophic coagulopathy, with a possible anaphylactoid reaction, may occur in uncomplicated pregnant women during or immediately after delivery [ 15 , 16 , 17 ].…”

Amniotic fluid embolism: lessons for rapid recognition and intervention

“…5 Bedside point-of-care thromboelastography could provide evidence of coagulopathy faster and earlier than blood testing in the laboratory. 6 Amniotic fluid embolism syndrome is rare and unpredictable, which makes it hard to suspect, but preventing a fatal outcome requires rapid, often drastic therapy. The three cases of our series can provide lessons about when to suspect the diagnosis and need for rapid drastic therapy.…”

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

“…60 It is proposed that the coagulation impairment is initially driven by massive fibrinogen consumption, reduced fibrinogen function and breakdown of cross-linked fibrin, elevation of D dimers, and reduced factor V levels. [61][62][63] Early hypofibrinogenemia drives severe PPH once cardiac output is restored after the initial collapse, Thromboelastography for Management of Postpartum Hemorrhage Collis, Bell 153 leading to further hypofibrinogenemia, then thrombocytopenia and clotting factor deficiency. Early hyperfibrinolysis appears to be a key feature and early use of tranexamic acid is essential.…”