Effects of rotational thromboelastometry–guided transfusion management in patients undergoing surgical intervention for postpartum hemorrhage: An observational study

Abstract

Background: Postpartum hemorrhage (PPH) can be associated with coagulopathy, which may be difficult to rapidly assess and may exacerbate blood loss. Rotational thromboelastometry (ROTEM) at the point of care can guide clinician choice of blood products and has been shown in some settings to reduce transfusions and improve outcomes. This hospital-based observational study aims to measure effects of a ROTEM-guided transfusion protocol on transfusion practice and clinical outcomes in patients with PPH managed in the operating theater. Study design and methods: We compared a retrospective cohort of 450 consecutive patients with PPH treated in the operating theater before the introduction of a ROTEM-guided transfusion algorithm in June 2016, with 450 patients treated after its introduction. Multivariate regression was used to evaluate the effect of ROTEM introduction on the primary outcome, patients requiring a packed red blood cell (PRBC) transfusion and adjusting for demographic and obstetric confounders. Secondary outcomes included other blood product transfusions, hysterectomy, and intensive care unit admission.Results: A total of 90 (20%) of patients treated prior to ROTEM introduction received a PRBC transfusion, compared with 102 (22.7%) of those treated after ROTEM introduction (95% confidence interval [CI] 1.0-2.0, p = .04). There was no difference in PRBC transfusion in patients undergoing caesarean section (95% CI 0.5-1.8, p = .99). There was a trend toward increased use of cryoprecipitate and reduced use of platelets and fresh frozen plasma after ROTEM introduction. Conclusion: In our institution, the introduction of ROTEM-guided transfusion did not reduce PRBC transfusion in patients with PPH treated in the operating theater.

Thromboelastometry-guided treatment algorithm in postpartum haemorrhage: a randomised, controlled pilot trial

“… 30 , 31 , 32 , 33 On the contrary, a recent observational study reported no benefit of ROTEM with regard to RBC transfusion in PPH. 39 However, in our study a small but statistically relevant difference in median total blood loss in favour of the ROTEM group was seen. Whether this is a result of more efficient haemostatic resuscitation is uncertain.…”

The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review

“…We included Four cohort studies[ 19 27 28 29 ] and one randomized clinical trial[ 30 ] out of 251 identified publications in this review after satisfying the inclusion criteria. Six ongoing clinical trials (ClinicalTrials.gov) were excluded as their result is still awaited [ Figure 1 and Table 1 ].…”

“…[ 17 18 ] However, extrapolating these results to PPH patients might lead to complications like allergy and lung injury. [ 19 ]…”

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

“…Tsang et al also compared PPH management before and after adoption of ROTEM in 900 women with estimated primary PPH >500 mL required management in the operating theater after vaginal delivery or >750 mL after caesarean delivery. 91 The mean total blood loss was 1,243 mL and only 32% of eligible patients received a ROTEM test, predominantly because the bleeding had stopped. The group did not observe a change in RBC transfusion or reduced cost of PPH treatment, but did show a reduction in platelet and FFP transfusion.…”