Point of Care coagulation assessments like ROTEM and TEG have been available for many years but data on outcome has been slower to emerge.
Hemorrhage management using traditional PT and PTT is a blunt instrument and has a slow laboratory turnaround time. Obstetric hemorrhage is different to trauma.
This is an obstetric hemorrhage report on 4 years of observational data from a tertiary care center using an algorithm based on FibTEM A5 assessment of hypofibrinogenemia. It resulted in a reduction in the number of units transfused and volume given, with less circulatory overload.
The authors note that coagulopathy is not observed in all women who suffer obstetric haemorrhage and cannot be predicted solely by blood loss, and also that women with placental abruption exhibited more severe coagulopathy and required higher doses of fibrinogen concentrate than women who bled due to other causes.
The results encourage point of care rather than formulaic blood product use to individualize cosgulopathy treatment.