Rotational thromboelastometry reference range during pregnancy, labor and postpartum period: A systematic review with meta-analysis

Ronenson, AlexanderM; Shifman, E. M.; Kulikov, A.V.; Raspopin, Yu.S.; Görlinger, Klaus; Ioscovich, AlexanderM; Tikhova, GalinaP

doi:10.4103/joacc.joacc_21_22

Cited by 2 publications

(2 citation statements)

References 44 publications

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“…ROTEM analysis at 28 weeks of gestation demonstrated normal values aside from a slightly prolonged extrinsically-activated test with tissue factor (EXTEM) clotting time of 76 seconds, with normal values during pregnancy between 31 and 67 seconds (Table 1). 8 PT, PTT, and platelet count were within normal limits. Given her hematologic history, abnormal ROTEM evaluation, and patient preference for an unmedicated delivery, it was decided to avoid neuraxial labor analgesia.…”

Section: Case Descriptionmentioning

confidence: 86%

A Case Report of Rotational Thromboelastometry-Assisted Decision Analysis for Two Pregnant Patients With Platelet Storage Pool Disorder

Hale¹,

Galanti²,

Langer

et al. 2023

A&A Practice

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Platelet storage pool disorders (PSPDs) constitute a diverse group of hematologic abnormalities, which share the common feature of a deficiency in the ability of platelets to aggregate. Parturients with PSPD can present management challenges to their care team when they present for childbirth, especially with regard to neuraxial anesthesia. We report a series of 2 deliveries from unrelated patients affected by PSPD. In particular, we highlight the utility of rotational thromboelastometry (ROTEM) and the need for a multidisciplinary approach to the care of patients with this hematologic abnormality.

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Section: Case Descriptionmentioning

confidence: 86%

A Case Report of Rotational Thromboelastometry-Assisted Decision Analysis for Two Pregnant Patients With Platelet Storage Pool Disorder

Hale¹,

Galanti²,

Langer

et al. 2023

A&A Practice

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“…До внедрения РОТЭМ в обоих центрах оценка и принятие решения о необ ходимости применения препаратов и трансфузионных сред, влияющих на систему гемостаза, основывались, как правило, на 4 стандартных тестах коагулограммы: АЧТВ, МНО, уровень фибриногена и тромбоцитов. Учитывая длительное время ожидания, необходимое Нес мотря на исходное состояние гиперкоагуляции и гиперфибриногенемии у беременных и рожениц [15], большая роль при интенсивной терапии ПРК отводит ся уровню фибриногена в плазме крови, который не обходимо поддерживать выше 2 г/л [16][17][18][19]. Важный факт -это наличие корреляции между уровнем фибри ногена по Клаусу (2,0 г/л) и показателем А5 FIBTEM (12 мм) [20], который позволяет использовать РОТЭМ в качестве ран ней диагностики гипофибриногене мии [21].…”

Section: Discussionunclassified

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

Ronenson

Raspopin

Shifman

et al. 2023

Annals of Critical Care

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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.

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Rotational thromboelastometry reference range during pregnancy, labor and postpartum period: A systematic review with meta-analysis

Cited by 2 publications

References 44 publications

A Case Report of Rotational Thromboelastometry-Assisted Decision Analysis for Two Pregnant Patients With Platelet Storage Pool Disorder

A Case Report of Rotational Thromboelastometry-Assisted Decision Analysis for Two Pregnant Patients With Platelet Storage Pool Disorder

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

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