Fibrinogen concentrates for post-partum haemorrhage? Do not miss the most relevant population!

Ickx, Brigitte; Samama, Charles C.M.

doi:10.1093/bja/aev033

Cited by 14 publications

(2 citation statements)

References 22 publications

(12 reference statements)

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“…Fibrinogen levels are typically elevated (approximately 5 g l À1 ) in pregnancy; however, we are currently unaware whether trigger levels above 1.5 to 2 g l À1 should be applied in obstetrics. [283][284][285] Fibrinogen functionality might be impaired by dilution, local or disseminated consumption. 286 The underlying obstetrical cause of bleeding should guide the clinical suspicion of impaired haemostasis.…”

Section: Haemostatic Treatment Of Obstetric Haemorrhagementioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

678

316

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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Section: Haemostatic Treatment Of Obstetric Haemorrhagementioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

678

316

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“…Coagulation Coagulation undergoes multiple changes and shifts towards an hypercoagulable state 78 , Fig 11.In the atlas fibrinogen, a procoagulant factor, rises during pregnancy78 , and undershoots postpartum. It reaches normal range within a few weeks but takes about 20 weeks to stabilize, reflecting the increased risk of hemorrhage79 . During pregnancy clotting becomes more rapid,78,80 as seen in the decline in clotting tests APTT-R, APTT-sec and PT-INR, which resolves within a few weeks postpartum.…”

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confidence: 99%

Pregnancy and postpartum dynamics revealed by an atlas of millions of lab tests

Bär

Cohen

Kohanim

et al. 2023

Preprint

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Pregnancy involves dynamic alterations in most physiological systems. Delivery initiates a transition to postpartum recovery, which similarly exhibits widespread dynamic changes. Physiological dynamics during pregnancy and after delivery have not been systematically analyzed at high temporal resolution in a large human population. Here, we present a dynamic atlas of 78 laboratory tests with weekly time resolution, spanning the period from 20 weeks pre-conception until 80 weeks postpartum, totaling 45 million measurements from over half a million pregnancies. Tests exhibited discontinuities and rebound effects after delivery, and showed extended recovery times of up to a year postpartum. The accuracy of the data revealed effects of preconception supplements and intricate temporal responses to changes in blood volume and renal filtration rate. The dynamical data allowed discrimination between distinct mechanistic models of adaptation in the thyroid axis. These results provide a comprehensive dynamic portrait of the systems physiology of pregnancy.

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