TY - JOUR
T1 - Impact of fibrinogen and prothrombin complex concentrate on clotting time in a model of obstetric hemorrhage
AU - Katz, Daniel J.
AU - Hira, Sharanpreet K.
AU - Sison, Matthew L.
AU - Getrajdman, Chloe S.
N1 - Funding Information:
This study was approved by the Institutional Review Board (IRB) of the Icahn School of Medicine at Mount Sinai, IRB#20–03466, approved on 08/18/2020. PCC and fibrinogen concentrate were provided by CSL Behring (Marburg, Germany) which had no involvement in the study itself. The study was partially funded by a Foundation for Anesthesia Education and Research (FAER) grant which underwent peer review. The grantor was not involved in study design or execution of the study nor the writing of the paper. Written and informed consent was obtained from 31 patients at the time of admission to the labor and delivery unit between 8 June 2021 and 16 July 2021. Women were eligible for the study if they were 18 years or older, English-speaking, and at term gestation (≥37 weeks). Patients were excluded if they met any of the following criteria: in active labor, known bleeding or clotting disorder, history of excessive bleeding or easy bruising suggesting coagulopathy, hypertensive disease of pregnancy, or on medication known to affect coagulation, including anti-coagulants and anti-platelets.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/6
Y1 - 2022/6
N2 - Study objective: Determine the impact of varying doses of fibrinogen concentrate and 4-factor prothrombin complex concentrate on clotting time as measured by thromboelastometry in an in-vitro model of dilutional coagulopathy. Design: In-Vitro Study. Setting: Tertiary academic center. Patients: 31 healthy term singleton gestation patients. Interventions: Blood was analyzed and diluted 95% with crystalloid. Washed red blood cells were added to simulate red blood cell transfusion. Two levels of fibrinogen repletion were then added to samples to simulate fibrinogen repletion in massive transfusion. Finally, 4-factor prothrombin complex concentrate (10 U/kg, 15 U /kg, or 25 U/kg) adjusted for body weight and estimated blood volume was added. Measurements: Samples were analyzed by thromboelastometry, and the main outcome was a FIBTEM clotting time > 80s. Main results: FIBTEM clotting times were prolonged after dilution. After repletion with fibrinogen and prothrombin complex concentrates 7/31 (22.5%) of samples had a prolonged FIBTEM clotting time (> 80s) in the 50% fibrinogen repletion arm and 0 (0%) had a prolonged clotting time in the 100% fibrinogen repletion arm. FIBTEM clotting times approached their baseline levels at each dose of prothrombin complex concentrate. Median clotting time in the 100% fibrinogen repletion arm was under 80s prior to the administration of prothrombin complex concentrate. Conclusions: Commonly cited doses for prothrombin complex concentrates in hemorrhage might be too high for the obstetric patient. After fibrinogen correction alone, several samples required no further correction, highlighting the importance of frequent testing at the point of care. Limitations of this study include the in vitro study design and ability to directly apply findings to patient care. Further studies are needed to elucidate the ideal dose of prothrombin complex concentrate for obstetric hemorrhage. Tweetable abstract: Fibrinogen concentrate and low dose 4-factor PCC corrected coagulopathy in in-vitro obstetric hemorrhage.
AB - Study objective: Determine the impact of varying doses of fibrinogen concentrate and 4-factor prothrombin complex concentrate on clotting time as measured by thromboelastometry in an in-vitro model of dilutional coagulopathy. Design: In-Vitro Study. Setting: Tertiary academic center. Patients: 31 healthy term singleton gestation patients. Interventions: Blood was analyzed and diluted 95% with crystalloid. Washed red blood cells were added to simulate red blood cell transfusion. Two levels of fibrinogen repletion were then added to samples to simulate fibrinogen repletion in massive transfusion. Finally, 4-factor prothrombin complex concentrate (10 U/kg, 15 U /kg, or 25 U/kg) adjusted for body weight and estimated blood volume was added. Measurements: Samples were analyzed by thromboelastometry, and the main outcome was a FIBTEM clotting time > 80s. Main results: FIBTEM clotting times were prolonged after dilution. After repletion with fibrinogen and prothrombin complex concentrates 7/31 (22.5%) of samples had a prolonged FIBTEM clotting time (> 80s) in the 50% fibrinogen repletion arm and 0 (0%) had a prolonged clotting time in the 100% fibrinogen repletion arm. FIBTEM clotting times approached their baseline levels at each dose of prothrombin complex concentrate. Median clotting time in the 100% fibrinogen repletion arm was under 80s prior to the administration of prothrombin complex concentrate. Conclusions: Commonly cited doses for prothrombin complex concentrates in hemorrhage might be too high for the obstetric patient. After fibrinogen correction alone, several samples required no further correction, highlighting the importance of frequent testing at the point of care. Limitations of this study include the in vitro study design and ability to directly apply findings to patient care. Further studies are needed to elucidate the ideal dose of prothrombin complex concentrate for obstetric hemorrhage. Tweetable abstract: Fibrinogen concentrate and low dose 4-factor PCC corrected coagulopathy in in-vitro obstetric hemorrhage.
KW - Fibrinogen concentrate
KW - Obstetric hemorrhage
KW - Prothrombin complex concentrate
KW - Thromboelastometry
UR - http://www.scopus.com/inward/record.url?scp=85124665633&partnerID=8YFLogxK
U2 - 10.1016/j.jclinane.2022.110687
DO - 10.1016/j.jclinane.2022.110687
M3 - Article
C2 - 35183833
AN - SCOPUS:85124665633
VL - 78
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
SN - 0952-8180
M1 - 110687
ER -