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

Peter W. Collins*, Graeme Lilley, Daniel Bruynseels, David Burkett-St. Laurent, Rebecca Cannings-John, Elizabeth Precious, Vincent Hamlyn, Julia Sanders, Raza Alikhan, Rachel Rayment, Alexandra Rees, Abigail Kaye, Judith E. Hall, Shantini Paranjothy, Andrew Weeks, Rachel E. Collis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

184 Citations (Scopus)

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
Original languageEnglish
Pages (from-to)1727-1736
Number of pages10
JournalBlood
Volume124
Issue number11
DOIs
Publication statusPublished - 11 Sept 2014

Bibliographical note

Acknowledgments
The authors thank the staff of the delivery suite at University Hospital of Wales for their many contributions to the study.

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