Point-of-care testing of coagulation and fibrinolytic status during postpartum haemorrhage: developing a thrombelastography®-guided transfusion algorithm
Abstract
Thrombelastography® is a monitor of coagulation and fibrinolytic status, with point-of-care applications in managing haemorrhaging patients. Advocates have suggested a possible role in managing obstetric haemorrhage. This study aims to develop a pregnancy-specific thrombelastography-guided transfusion algorithm, which could be integrated into the management of postpartum haemorrhage. In this prospective observational study, 57 healthy, term-parturients provided pre-caesarean whole blood specimens for thrombelastography analyses. Specimens were processed according to a standardised protocol involving simultaneous analyses using three assays: native (non-activated); kaolin-activated; and kaolin and tissue factor-activated (RapidTEG®). For each assay, the following thrombelastography parameters were measured: reaction time (minutes); clot formation kinetics time (minutes); maximum amplitude (mm); and a angle (degree). Subsequent reference values were used to establish assay-specific reference intervals. For all thrombelastography parameters studied, reference values obtained using a non-activated assay differed from the corresponding values obtained using activated assays, and also demonstrated greater inter-sample variability. From the assay-specific reference intervals obtained, it was possible to establish a pregnancy-specific thrombelastography-guided transfusion algorithm. Specific features of this transfusion algorithm included the preferential use of activated assays, the need for duplicates and a recommendation that an initial baseline thrombelastography measurement is established for subsequent serial comparisons. This transfusion algorithm has been developed to assist with assessment of coagulation and fibrinolytic status during postpartum haemorrhage.
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Point-of-care viscoelastic tests may direct resuscitative efforts to avoid over treatment.
“Additionally, these point-of-care tests may direct resuscitative efforts to avoid over treatment (89–91).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [91]
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- Authors
- Hill, J. S., Devenie, G., & Powell, M.
- Affiliations
- Auckland City Hospital (NZ)
- Corresponding author
- Hill, J. S.
- Venue
- Anaesthesia and Intensive Care
- Publisher
- SAGE Publications
- Published
- 2012-11
- Volume
- 40
- Issue
- 6
- Pages
- 1007-1015
- ISSN
- 0310-057X (ISSN-L)
- 1448-0271
- OpenAlex
- W155542165
- Cited by
- 50
- References
- 32
- Citations by year
- 2025: 3 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 7 · 2018: 2 · 2017: 6 · 2016: 2 · 2015: 4 · 2014: 5 · 2013: 4
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anaesthesia and Intensive Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Auckland District Health Board
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- thromboelastography, postpartum hemorrhage, obstetric hemorrhage, transfusion algorithm, coagulation status, fibrinolysis, reference values, tissue factor activation, point-of-care testing
- MeSH terms
- Adult, Algorithms, Blood Coagulation, Blood Coagulation Tests, Blood Transfusion, Cesarean Section, Female, Fibrinolysis, Postpartum Hemorrhage, Humans, Reference Values, Thrombelastography, Point-of-Care Systems
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