Introduction of an Algorithm for ROTEM-guided Fibrinogen Concentrate Administration in Major Obstetric Hemorrhage

Mallaiah, S.; Barclay, P.; Harrod, I.; Chevannes, C.; Bhalla, Ashish

doi:10.1097/01.aoa.0000472724.81984.71

Cited by 3 publications

(9 citation statements)

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Section: Discussionmentioning

confidence: 96%

“…29 A significant reduction in total use of allogeneic blood products was found when fibrinogen concentrate was infused based on FIBTEM A5 values <7mm, or values <12mm with ongoing bleeding. 29 This is important considering that guidelines on postpartum bleeding are recommending the use of fixed-ratio protocols. The observational counterpart of the OBS2 found no significant hemostatic impairment when fresh frozen plasma was withheld in FIBTEM A5 values >15mm.…”

Section: Accepted Articlementioning

confidence: 97%

“…23 Another study from the United Kingdom compared a fixed-ratio transfusion protocol with targeted fibrinogen replacement therapy on the basis of FIBTEM A5 results and obstetric hemorrhage >1500mL. 29 A significant reduction in total use of allogeneic blood products was found when fibrinogen concentrate was infused based on FIBTEM A5 values <7mm, or values <12mm with ongoing bleeding. 29 This is important considering that guidelines on postpartum bleeding are recommending the use of fixed-ratio protocols.…”

Section: Accepted Articlementioning

confidence: 99%

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Clinical value of early viscoelastometric point‐of‐care testing during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands

Ramler

Gillissen

Henriquez

et al. 2021

Acta Obstet Gynecol Scand

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The TeMpOH-2 study was supported by an internal grant from Sanquin Research (PPOC 13-029).Tem International GmbH (Munich, Germany) provided the Leiden University Medical Center with a ROTEM® device on the basis of a loan agreement without additional charge. The other two hospitals already owned ROTEM® devices that were made available for this study. Reagents used in the ROTEM® devices were at the expense of the study without discount.

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Section: Discussionmentioning

confidence: 96%

Section: Accepted Articlementioning

confidence: 97%

Section: Accepted Articlementioning

confidence: 99%

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Clinical value of early viscoelastometric point‐of‐care testing during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands

Ramler

Gillissen

Henriquez

et al. 2021

Acta Obstet Gynecol Scand

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“…POC testing methods like rotational thromboelastometry (ROTEM) with its FIBTEM component, which evaluates the fibrinogen level (with results available within 10 min), have been shown to have a strong correlation with laboratory testing, thereby enabling timely decision making for goal-directed transfusion with a significant reduction in unnecessary transfusions and their associated morbidity. 10,[12][13][14] ROTEM is not affordable for LMICs; however, a nearly forgotten conventional point-of-care clotting time (POCCT) test of whole blood (without any additive) has been suggested to indicate coagulation failure if it fails to clot within 5-10 min. 15,16 To the best of our knowledge, no research has so far correlated the conventional POCCT with plasma fibrinogen concentration.…”

Section: Introductionmentioning

confidence: 99%

“…Point‐of‐care (POC) testing is a promising tool. POC testing methods like rotational thromboelastometry (ROTEM) with its FIBTEM component, which evaluates the fibrinogen level (with results available within 10 min), have been shown to have a strong correlation with laboratory testing, thereby enabling timely decision making for goal‐directed transfusion with a significant reduction in unnecessary transfusions and their associated morbidity 10,12–14 …”

Section: Introductionmentioning

confidence: 99%

Point‐of‐care blood clotting test and its correlation with fibrinogen level: Potential in goal‐directed transfusion in postpartum hemorrhage

Mishra

Ekka

Pal

et al. 2021

Intl J Gynecology & Obste

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Objective To study the correlation of conventional point‐of‐care clotting test (POCCT) of whole blood with laboratory fibrinogen levels in women with primary major postpartum hemorrhage (PPH) to generate evidence regarding its potential in rationalizing transfusion of blood components for supplementing fibrinogen. Methods A total of 68 samples were studied: 40 from women with primary major PPH, 20 from women without PPH, and eight samples of Fresh Frozen Plasma (FFP). POCCT was performed in the PPH and non‐PPH groups and at the same time, sample for laboratory fibrinogen was sent. Values were correlated using Pearson's correlation coefficient (r). Depending upon the laboratory fibrinogen values, POCCT in the PPH group was divided into three subgroups of less than 7, 7–11, and more than >11 min as subgroups 1, 2, and 3, respectively. Results Women in the PPH group (n = 40) had a mean fibrinogen level of 346.15 ± 143.37 mg% with a significant negative correlation with POCCT (r = −0.69, P < 0.001). Mean fibrinogen levels of non‐PPH group and FFP samples were 602.1 ± 169.72 and 286.75 ± 103.42 mg%, respectively. PPH subgroups 1, 2, and 3 had mean fibrinogen of 452.2 ± 141.8, 332.58 ± 138.51, and 158.71 ± 145 mg%, respectively. These values may potentially guide FFP transfusions. Conclusion POCCT is easy, costs nothing and has a potential role in rationalizing FFP transfusion in low‐ and middle‐income countries.

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Clinical Value of Early Viscoelastometric Point-of-Care Testing During Postpartum Hemorrhage for the Prediction of Severity of Bleeding; A Multicenter Prospective Cohort Study in the Netherlands

Ramler¹,

Gillissen²,

Henriquez³

et al. 2022

Obstetric Anesthesia Digest

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(Acta Obstet Gynecol Scand. 2021;100:1656–1664) Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Early intervention before the development of coagulopathy can reduce hemostatic impairments, preventing the need for interventions including hysterectomy and massive blood transfusion. Tests currently used during PPH to evaluate clotting status include the FIBTEM and fibrinogen measurement. Results from these tests unfortunately can take up to an hour, during which time significant blood may be lost. Results of clot firmness from FIBTEM at 5 minutes (A5 measurement) can indicate the potential for PPH in only 15 minutes. In this multicenter study in the Netherlands researchers compared blood loss within 24 hours of birth to the results of these tests to determine accuracy in predicting severe PPH with blood loss ≥2000 mL.

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Introduction of an Algorithm for ROTEM-guided Fibrinogen Concentrate Administration in Major Obstetric Hemorrhage

Cited by 3 publications

References 0 publications

Clinical value of early viscoelastometric point‐of‐care testing during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands

Clinical value of early viscoelastometric point‐of‐care testing during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands

Point‐of‐care blood clotting test and its correlation with fibrinogen level: Potential in goal‐directed transfusion in postpartum hemorrhage

Clinical Value of Early Viscoelastometric Point-of-Care Testing During Postpartum Hemorrhage for the Prediction of Severity of Bleeding; A Multicenter Prospective Cohort Study in the Netherlands

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