Use of clotting factors and other prohemostatic drugs for obstetric hemorrhage.
OBJECTIVE
To guide the optimal use of blood products and to clarify the indications for prohemostatic drugs in obstetric hemorrhage.


RESULTS
The literature emphasizes the usefulness of transfusing packed red blood cells, fresh frozen plasma and platelets earlier and in defined ratios to prevent dilutional coagulopathy during obstetric hemorrhage. The value of fibrinogen concentrate and prohemostatic drugs such as tranexamic acid and recombinant factor VIIa is also pointed out.


CONCLUSIONS
It seems reasonable to use blood products for transfusion earlier and in a 1: 1 fresh frozen plasma: red blood cell ratio during acute obstetric hemorrhage; however, this analysis is mainly based on trauma literature. Fibrinogen concentrate should be added if the fibrinogen plasma level remains below 1.0 g l(-1) and perhaps even as soon as it falls below 1.5-2.0 g l(-1); the addition of tranexamic acid (1 g) is cheap, likely to be useful and appears safe. Data on the proactive administration of platelets are insufficient to recommend this practice routinely. Presently, recombinant factor VIIa (60-90 microg kg(-1)) is advocated only after failure of other conventional therapies, including embolization or conservative surgery, but prior to obstetric hysterectomy. Prospective randomized controlled trials are highly desirable.
Mercier
Frédéric J
FJ
Département d'Anesthésie Réanimation, Hôpital Antoine Béclère, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Clamart, France. frederic.mercier@abc.aphp.fr
Bonnet
Marie-Pierre
MP
D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016913:Blood Component Transfusion / Q000379:methods; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa