Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Abstract

Objectives: To establish whether reagent-supported thrombelastometry with the rotation thrombelastometry system (ROTEM) point-of-care device correlated with fibrinogen level in postpartum haemorrhages.

Design: Prospective observational study.

Population and setting: Ninety-one women at the third trimester of pregnancy: 37 with postpartum haemorrhage (study group) and 54 without abnormal bleeding (control group).

Methods: Standard laboratory test results were compared with those obtained at bedside from the ROTEM with the FIBTEM test (54 tests in the control group and 51 in the study group).

Main outcome measures: Analysis of correlations between fibrinogen levels and FIBTEM test results: clotting time (CT), clot amplitude at 5 and 15 minutes (CA5; CA15) and maximal amplitude [maximum clot firmness (MCF)].

Results: Median fibrinogen level was significantly lower in the haemorrhage group than in the control group (3.4 and 5.1 g/l, respectively, P < 0.0001). Median CT was higher in the haemorrhage group than in the control group (P = 0.05). CA5, CA15 and MCF were significantly lower in the haemorrhage group than in controls (P < 0.0001) and strongly correlated with fibrinogen levels in both groups (r = 0.84-0.87, P < 0.0001). A cut-off value of CA5 at 5 mm and CA15 at 6 mm presented an excellent sensitivity (100% for both parameters) and a good specificity (respectively 85 and 88%) to detect fibrinogen levels <1.5 g/l in postpartum haemorrhage. Conclusions The early parameters obtained from the FIBTEM test correlated well with fibrinogen levels. ROTEM might be helpful in guiding fibrinogen transfusion during postpartum haemorrhage.