Abstract
Massive obstetric haemorrhage remains a major cause of maternal death attributable to hypofibrinogenaemia. Transfusion of large volumes of fresh frozen plasma (FFP) is required to normalise fibrinogen levels. We compared the efficacy of FFP (F group) with that of FFP plus fibrinogen concentrate (F + F group) in massive obstetric haemorrhage. In this retrospective study, we compared the medical charts (2004–2016) of 137 patients with <150 mg/dl fibrinogen treated with F + F (n = 47; after August 2009) or F (n = 56; before August 2009). Although fibrinogen concentrate was only administered in severe cases, the FFP/red blood cell concentrate (RCC) ratio was significantly lower in the F + F group than in the F group. A sub-group analysis of cases requiring ≥18 RCC units showed that the F + F group received significantly less FFP than the F group (40.2 ± 19.6 versus 53.4 ± 18.5 units; P = 0.047) and showed significantly less pulmonary oedema (24.0% vs 57.1%; P < 0.05) in the absence of any significant differences in pre-transfusion coagulation, estimated blood loss, or RCC transfusion volume. Administration of fibrinogen concentrate increased the rate of fibrinogen supplementation five-fold and reduced FFP dosage, the FFP/RCC ratio, and the incidence of pulmonary oedema.
Highlights
Are not widely available[8]
Within the F +F group, we analysed the difference between the post- and pre-administration fibrinogen level (Δfibrinogen) and divided this by the duration of administration to calculate the rate of fibrinogen increase (Δfibrinogen/h) in 32 patients treated with 3 g fibrinogen concentrate and 15 patients who received 6 g fibrinogen concentrate (Table 2)
Administration of fibrinogen concentrate reduced the incidence of pulmonary oedema and did not cause thrombosis in any of the patients included in this study
Summary
Are not widely available[8]. Fibrinogen concentrate can be used “off label” in acquired fibrinogen deficiencies and is used as the standard treatment in some countries such as Austria, Germany, and Switzerland. Fibrinogen is an essential protein involved in platelet aggregation and blood coagulation. The use of fibrinogen and other coagulation factor concentrates that include high levels of fibrinogen should provide therapeutic benefits by efficiently restoring the levels of key coagulation factors. There are few studies comparing the efficacy of these blood products in obstetric patients with that of a relevant control group[9,10,11,12,13,14], and no reports have investigated this in a controlled clinical setting in individuals with hypofibrinogenaemia[15] because these are generally emergency medicine patients. In the present study we retrospectively compared the effects of administering a fibrinogen concentrate to patients treated for hypofibrinogenaemia (fibrinogen < 150 mg/dl) attributable to massive obstetric haemorrhage with those observed in patients treated with FFP alone, including reduced complications
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