Efficacy of rotational thromboelastometry for diagnosis and correction of coagulopathy in massive postpartum hemorrhage: a cohort retrospective multi-center DiPTEM study
Issue 1 (2023) , DIAGNOSTICS AND INTENSIVE CARE IN OBSTETRICS
Issue 1 (2023)
DIAGNOSTICS AND INTENSIVE CARE IN OBSTETRICS

Efficacy of rotational thromboelastometry for diagnosis and correction of coagulopathy in massive postpartum hemorrhage: a cohort retrospective multi-center DiPTEM study

https://doi.org/10.21320/1818-474X-2023-1-34-42
Published 31.01.2023
Alexandr M. Ronenson
Tver State Medical University, Tver, Russia; E. M. Bakunina Tver Regional Clinical Perinatal Centre, Tver, Russia
https://orcid.org/0000-0002-2468-297X
Yu. S. Raspopin
Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia; Krasnoyarsk Regional Clinical Center for the Protection of Mothers and Children, Krasnoyarsk, Russia
https://orcid.org/0000-0001-5550-1628
E. M. Shifman
Moscow Regional Research and Clinical Institute, Moscow, Russia
https://orcid.org/0000-0002-6113-8498
A. V. Kulikov
Ural State Medical University, Yekaterinburg, Russia
https://orcid.org/0000-0002-7768-4514
A. M. Ioscovich
Shaare Zedek Medical Center, Jerusalem, Israel
https://orcid.org/0000-0001-6449-0254
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Keywords

postpartum hemorrhage
hemorrhagic disorders
thrombelastography
resh frozen plasma
fibrinogen

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Ronenson A.M., Raspopin Y.S., Shifman E.M., Kulikov A.V., A. M. Ioscovich A.M.I. Efficacy of rotational thromboelastometry for diagnosis and correction of coagulopathy in massive postpartum hemorrhage: a cohort retrospective multi-center DiPTEM study. Annals of Critical Care. 2023;(1):34–42. doi:10.21320/1818-474X-2023-1-34-42.
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Abstract

INTRODUCTION: Continuous monitoring of the hemostasis system during postpartum hemorrhage is an essential aspect of intensive care. Rotational thromboelastometry (ROTEM) provides rapid and differentiated detection of hemostasis system disorders. OBJECTIVE: To evaluate the effect of implementing the rotational thromboelastometry on the need for blood transfusion in massive postpartum hemorrhage in the practice of perinatal centers. MATERIALS AND METHODS: A retrospective cohort multicenter study was conducted in two perinatal centers. The BEFORE group included females with massive postpartum hemorrhage (PPH) (> 30 % of circulating blood volume (CBV) or > 2 L) within 2 years prior to ROTEM implementation in tertiary care hospitals; the AFTER group included females with massive postpartum hemorrhage within 2 years after ROTEM implementation. The primary endpoint of the study was a comparative evaluation of the frequency of fresh frozen plasma (FFP) transfusion for hemostasis correction in massive PPH before and after ROTEM implementation as an urgent method for coagulopathy diagnosis. RESULTS: A total of 97 patients were included in the study: 48 in the BEFORE group and 49 in the AFTER group. A significant relative risk (RR) of reduced frequency of FFP transfusion RR = 0.53 (0.32, 0.85; p = 0.009) with NNT = 3.6 after implementation of ROTEM into clinical practice was found. The frequency of cryoprecipitate transfusion increased. Analysis of cases of PPH over 50 % of the CBV (PPH in the BEFORE and AFTER groups 68.2 ± 12.4 and 72.3 ± 35.9, respectively, p = 0.673) showed a twofold significant risk of reducing the number of parturient women requiring FFP transfusion: RR = 0.5 (0.25, 0.99); p = 0.049), with NNT = 2. CONCLUSION: Rapid information on the status of the hemostasis system can reduce unnecessary FFP transfusion. Introducing the ROTEM method into the clinical practice of obstetric hospitals will improve the outcomes of intensive care for one of the most challenging categories of patients — postpartum women with massive postpartum hemorrhage.

https://doi.org/10.21320/1818-474X-2023-1-34-42
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