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

Collins, Peter, Lilley, Graeme, Bruynseels, Daniel, Burkett-St. Laurent, David, Cannings-John, Rebecca, Precious, Elizabeth, Hamlyn, Vincent, Sanders, Julia, Alikhan, Raza, Rayment, Rachel, Rees, Alexandra, Kaye, Abigail, Hall, Judith, Paranjothy, Shantini, Weeks, Andrew and Collis, Rachel E. 2014. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood 124 (11) , pp. 1727-1736. 10.1182/blood-2014-04-567891

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > R Medicine (General)
R Medicine > RG Gynecology and obstetrics
Publisher: American Society of Hematology
ISSN: 0006-4971
Date of Acceptance: 29 June 2014
Last Modified: 19 Feb 2019 23:15
URI: http://orca.cf.ac.uk/id/eprint/78552

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