title: Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study.
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.
authors.affiliation: Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom; Institute of Infection and Immunity, Critical Illness Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom;
authors.forename: Peter W
authors.initials: PW
authors.lastname: Collins
authors.affiliation: Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Graeme
authors.initials: G
authors.lastname: Lilley
authors.affiliation: Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Daniel
authors.initials: D
authors.lastname: Bruynseels
authors.affiliation: Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: David Burkett-St
authors.initials: DB
authors.lastname: Laurent
authors.affiliation: Institute of Translation, Innovation, Methodology and Engagement, South East Wales Trials Unit, Cardiff University School of Medicine, Cardiff, United Kingdom;
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cannings-John
authors.affiliation: Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Precious
authors.affiliation: Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Vincent
authors.initials: V
authors.lastname: Hamlyn
authors.affiliation: Institute of Translation, Innovation, Methodology and Engagement, South East Wales Trials Unit, Cardiff University School of Medicine, Cardiff, United Kingdom; Department of Obstetrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Julia
authors.initials: J
authors.lastname: Sanders
authors.affiliation: Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Raza
authors.initials: R
authors.lastname: Alikhan
authors.affiliation: Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Rachel
authors.initials: R
authors.lastname: Rayment
authors.affiliation: Department of Obstetrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Alexandra
authors.initials: A
authors.lastname: Rees
authors.affiliation: Department of Obstetrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Abigail
authors.initials: A
authors.lastname: Kaye
authors.affiliation: Institute of Infection and Immunity, Critical Illness Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom; Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Judith E
authors.initials: JE
authors.lastname: Hall
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, United Kingdom; and.
authors.forename: Shantini
authors.initials: S
authors.lastname: Paranjothy
authors.affiliation: Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Weeks
authors.affiliation: Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, Cardiff, United Kingdom;
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Collis
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D017707:Erythrocyte Transfusion; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000628:therapy*
chemical_list: D015415:Biomarkers; D005337:Fibrin