Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial

Wikkelsø, Anne; Edwards, Hellen McKinnon; Afshari, Arash; Stensballe, Jakob; Langhoff‐Roos, Jens; Albrechtsen, Charlotte; Ekelund, Kim; Hanke, Gabriele; Secher, E; Sharif, Heidi; Pedersen, Lars Møller; Troelstrup, Ane; Lauenborg, Jeannet; Mitchell, Anja U.; Fuhrmann, Lone; Svare, Jens; Madsen, Mikkel; Bødker, Birgit; Møller, Ann Merete; Christensen, Mette Krogh; Ramsing, Benedicte Utke; Jensen-Gadegaard, Peter; Engskov, Anna Sellgren; Wulff, C. B.; Berntsen, Marianne; Andersen, Kristian J.; Classen, Volker; Opstrup, Pernille; Lundstrøm, Lars Hyldborg; Flindt, Marianne S.; Lunde, Jens; Lassen, Birgit; Andersson, Mette; Winther-Olsen, Marie; Hougaard, Sine; Andersen, Christine; Petersen, Maria Hvidberg; Nielsen, Christian Skovgaard; Sønderskov, Michelé Lefort; Winkel, Rasmus; Johansen, Mathias; Søgaard, Marie; Madsen, Mette Gøttge; Okkels, Casper; Berthelsen, Rasmus Ehrenfried; Linnet, Karen Elisabeth; Stendall, Line; Darfeld, Iben; Pedersen, Louise

doi:10.1093/bja/aeu444

Cited by 229 publications

(182 citation statements)

References 24 publications

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“…Similar clinical outcomes and increments in fibrinogen have been reported for cryoprecipitate and fibrinogen concentrates, but these are based on limited data [30].…”

Section: Fibrinogenmentioning

confidence: 61%

Massive Postpartum Hemorrhage: Protocol and Red Code

Masip¹,

Almeida-Toledano²,

Ferrero-Martínez³

et al. 2017

Obstetrics

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Postpartum hemorrhage (PPH) is the leading cause of maternal death. In developing countries, approximately 8% of maternal death is caused by PPH. Protocols should provide a standardized approach to evaluate and monitor the patients. A standard protocol must be recognized by the institution and must be accepted and known by all team members. Additionally, it is important to have a massive obstetric hemorrhage protocol (red code) for those patients with an important bleeding who require blood products available as soon as possible. In the red code activation protocol there are several key points to consider: the management algorithm must be known and accepted by all team members, a clear and effective communication between the team must be established and all the participants must know the role they play. Massive obstetric hemorrhage has a multidisciplinary implication: obstetricians, anesthesiologists, pediatricians, midwife, nurses, auxiliary staff, and laboratory blood bank staff. The active participation of the multidisciplinary team in simulations before the protocols implementation facilitates the evaluation of critical points and subsequent changes before their final application, the assessment of the adequacy of circuits and infrastructure, as well as a better protocols compliance.

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“…Similar clinical outcomes and increments in fibrinogen have been reported for cryoprecipitate and fibrinogen concentrates, but these are based on limited data [30].…”

Section: Fibrinogenmentioning

confidence: 61%

Massive Postpartum Hemorrhage: Protocol and Red Code

Masip¹,

Almeida-Toledano²,

Ferrero-Martínez³

et al. 2017

Obstetrics

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“…In this study, 249 patients with active postpartum hemorrhage (PPH) were randomized to either receive 2 g of fibrinogen concentrate or placebo (saline). 50 There was no difference in the rate of allogeneic transfusion or mortality between groups. However, patients in the group who received fibrinogen concentrate had fibrinogen levels of >4 g at inclusion into the study, and therefore, it is possible that patients with hypofibrinogenemia and bleeding, ie, those at the highest risk of major bleeding, did not receive the therapy, so any benefit could not be observed.…”

Section: Obstetricsmentioning

confidence: 84%

“…However, patients in the group who received fibrinogen concentrate had fibrinogen levels of >4 g at inclusion into the study, and therefore, it is possible that patients with hypofibrinogenemia and bleeding, ie, those at the highest risk of major bleeding, did not receive the therapy, so any benefit could not be observed. 50 We await the results of a recently completed multicenter randomized trial on early administration of fibrinogen concentrate in obstetric hemorrhage. 51 In this trial, the main rationale for choosing fibrinogen concentrate as a source of fibrinogen replacement over cryoprecipitate was the inherent delays associated with giving cryoprecipitate (ie, time for thawing and transportation).…”

Section: Obstetricsmentioning

confidence: 99%

Cryoprecipitate transfusion: current perspectives

Wong¹,

Curry²

2016

IJCTM

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“…The recently published multicenter FIB-PPH trial from Denmark randomized 249 women with PPH to receive either 2 g empiric FC versus saline placebo, examining a primary outcome of RBC transfusion up to 6 weeks postpartum. 39 No significant difference was found, with 20% of the women treated with FC receiving postpartum RBC transfusion as compared with 22% of the placebo group (P ϭ 0.88). However, only 2.2% of the subjects had fibrinogen levels Ͻ2 g/L at baseline; accordingly, the results suggest only that empiric FC in PPH with normal or near-normal fibrinogen levels does not significantly alter RBC transfusion incidence.…”

Section: Fibrinogen Replacement In Postpartum Hemorrhagementioning

confidence: 89%

Postpartum hemorrhage: a continuing challenge

Lockhart

2015

Hematology

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Obstetric hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Many postpartum hemorrhages (PPHs) do not have identifiable risk factors; maternity units should therefore have obstetric hemorrhageprotocols in place for all parturients as every pregnancy has the potential to be complicated by hemorrhage. This review will examine the epidemiology of PPH as well as current recommendations for key elements in obstetric hemorrhage protocols. Recent advances in hematologic management of PPH will be also be reviewed, including: (1) recognition of hypofibrinogenemia as a risk factor for severe PPH, (2) use of antifibrinolytic therapy, and (3) strategies for fibrinogen replacement therapy.

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Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial

Abstract: ClinicalTrials.gov: http://clinicaltrials.gov/show/NCT01359878. Published protocol: http://www.trialsjournal.com/content/pdf/1745-6215-13-110.pdf.

Cited by 229 publications

References 24 publications

Massive Postpartum Hemorrhage: Protocol and Red Code

Massive Postpartum Hemorrhage: Protocol and Red Code

Cryoprecipitate transfusion: current perspectives

Postpartum hemorrhage: a continuing challenge

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