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

• Published in: Blood Vol. 124; no. 11; pp. 1727 - 1736
• Main Authors: Collins, Peter W., Lilley, Graeme, Bruynseels, Daniel, Laurent, David Burkett-St, Cannings-John, Rebecca, Precious, Elizabeth, Hamlyn, Vincent, Sanders, Julia, Alikhan, Raza, Rayment, Rachel, Rees, Alexandra, Kaye, Abigail, Hall, Judith E., Paranjothy, Shantini, Weeks, Andrew, Collis, Rachel E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 11.09.2014
• Subjects: Adult; Biomarkers - blood; Blood Coagulation; Erythrocyte Transfusion; Female; Fibrin - metabolism; Humans; Postpartum Hemorrhage - blood; Postpartum Hemorrhage - therapy
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2014-04-567891

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. •Fibtem is an early and rapidly available biomarker for predicting progression of moderate to severe postpartum hemorrhage.•Fibtem was predictive of need for blood transfusion and invasive procedures, bleeds >2500 mL, duration of bleed, and time in high dependency.