The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review
Saudi journal of anaesthesia. 2023;17(1):23-32
BACKGROUND The utility of instantaneous evaluation of coagulation during primary postpartum haemorrhage (PPH) is paramount in the context of empirical blood product transfusion-related risk of dilutional and consumptive coagulopathy and circulatory overload. METHODS A profound screening of electronic databases till August 15, 2022 was carried out after being enlisted in PROSPERO (CRD42021275514). Randomized control studies, comparative cohort studies, and cross-sectional studies comparing point-of-care viscoelastic test guided blood product transfusion with empirical transfusion in patients with PPH were included. RESULTS We retrieved five studies, with a total of 1914 parturient with PPH. Patients receiving transfusion based upon point of care viscoelastic tests had lesser risk of having emergency hysterectomy (Odds ratio (OR) = 0.55, 95% CI 0.32-0.95, I(2) = 7%), transfusion-associated circulatory overload (TACO) (OR = 0.03, 95% CI 0.00-0.50), reduced transfusion of fresh frozen plasma (OR = 0.07, 95% CI 0.04-0.14, I(2) = 89%), platelets (OR = 0.51, 95% CI 0.28-0.91, I(2) = 89%), packed red blood cell transfusion (OR = 0.70, 95% CI 0.55-0.88, I(2) = 89%), and had better cost-effective treatment [Mean difference (MD) = -357.5, 95% CI - 567.75 to -147.25, I(2) = 93%] than patient received empirical transfusion. However, there was no significant difference in the requirement of ICU admissions (OR = 0.77, 95% CI = 0.46-1.29, I(2) = 82%). No mortality was detected across the studies. CONCLUSIONS Point of care viscoelastic assessment guided transfusion in PPH confederates with reduced morbidity. Nevertheless, more studies on the triggering values for transfusion, long-term survival, and cost-benefit in patients with PPH are warranted to establish its utility.
Hemostasis in Neonates with Perinatal Hypoxia-Laboratory Approach: A Systematic Review
Seminars in thrombosis and hemostasis. 2022
Birth asphyxia, with an estimated prevalence of 1 to 6 per 1,000 live births, may lead to multiorgan dysfunction due to impaired oxygen and/or blood supply to various organ systems, including the hemostatic system. Coagulopathy, a common complication of perinatal asphyxia, has been described since the 1960s. The aim of this study was to systematically review the literature for records on the use of hemostasis tests in the evaluation of coagulation disorders, in neonates who had suffered from perinatal hypoxia or asphyxia. We identified published studies by searching PubMed and Scopus, up until April 2022. The literature search retrieved 37 articles fulfilling the inclusion criteria of the review. According to the bibliography, thrombocytopenia is commonly associated with perinatal hypoxia/asphyxia. The thrombocytopenia is usually described as mild and platelets return to normal levels by the 10th day of life. Additionally, hypoxic neonates usually present with a hypocoagulable profile, as reflected by the prolongation of standard coagulation tests, including prothrombin time, activated partial thromboplastin time, and international normalized ratio, findings commonly associated with disseminated intravascular coagulation, and by the reduction of the levels of the physiologic inhibition of coagulation system. A few studies thus far using ROTEM/TEG in hypoxic neonates have come to the same conclusion as well; hypoxic newborns seem to be characterized by a hypocoagulable profile compared with healthy neonates. It should be emphasized, however, that standard coagulation tests provide only a rough estimation of the true bleeding or thrombotic risk of hypoxic neonates. On the contrary, viscoelastic methods seem to be more precise in the early detection of hemostasis disorders in the neonatal population. However, until now, there was uncertainty as to the most appropriate coagulation assays for diagnosis and management of coagulation derangement in neonates with perinatal hypoxia indicating the need for further research on this field.
227-POS : Thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) in pregnancy: A systematic review
Pregnancy Hypertension. 2015;5((1):):114-5.
OBJECTIVES To evaluate the current position of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in clinical obstetric practice. METHODS A search of the literature was performed on the following databases PubMed MEDLINE, EMBASE and the Cochrane Database of Systematic reviews. All articles published after 1990 until February 2013 and written in English, German, French, Spanish, Italian and Dutch concerning human pregnancies were eligible for inclusion. Eligible papers were subdivided in normal and complicated pregnancy outcomes and processed. RESULTS 287 articles were found, of which 60 are included in the review. All studies with TEG/ROTEM performed in uncomplicated pregnancies, found significant changes towards a hypercoagulable state, especially in the third trimester. Hypercoagulability was found to persist till at least 3 weeks postpartum. In postpartum hemorrhage FIBTEM-ROTEM correlated well with the measured fibrinogen levels. Although, in severe preeclampsia with low platelets (<100.000/mm(3)) or in HELLP-syndrome changes in TEG/ROTEM associated with hypocoagulability are described, most studies were not able to show any significant differences between healthy pregnant women and women with mild preeclampsia. Miscarriage is associated with hypercoagulable changes in TEG/ROTEM compared to healthy non-pregnant and pregnant women. 26 case reports concerning women with specific coagulation disorders were identified and TEG/ROTEM was used for guiding therapeutic decision making. CONCLUSIONS In individual women with coagulation disorders TEG/ROTEM can be useful to provide complementary information for "decision-making" and "therapy-guidance". The use of TEG(®) or ROTEM(®)-analysis in the general obstetric practice, is at this time not recommended. Further research with standardized processing of data is most promising for bedside monitoring and of postpartum hemorrhage. DISCLOSURES A.C. Bolte: None. F.J. Hermans: None. L.E. Van Rheenen-Flach: None.Copyright 2014.