Thromboelastography versus Standard Coagulation Assays in Patients with Postpartum Hemorrhage

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Point-of-Care Testing

Background:

• Postpartum hemorrhage (PPH) frequently leads to coagulopathy and hypofibrinogenemia.
• Rapid fibrinogen assessment is critical for timely cryoprecipitate administration.
• Thromboelastography (TEG) offers potential for rapid coagulopathy assessment in PPH.

Purpose of the Study:

• To evaluate the accuracy of TEG in reflecting coagulopathy during ongoing PPH.
• To compare TEG findings with standard coagulation assays in PPH patients.
• To determine if TEG can guide resuscitation in PPH.

Main Methods:

• Retrospective cohort study of patients with PPH (blood loss >1,000 mL) from 2016-2019.
• Simultaneous TEG and standard coagulation parameters were analyzed.
• Statistical analysis included Mann-Whitney, Fisher's exact, Kruskal-Wallis, Spearman's rho, and logistic regression.

Main Results:

• TEG variables significantly correlated with standard assays: prolonged R with increased PTT, prolonged K and decreased α angle with decreased fibrinogen, and decreased maximum amplitude with decreased platelets.
• Significant correlations were observed even in patients with hypofibrinogenemia.
• Patients undergoing TEG had higher blood loss and required more interventions.

Conclusions:

• TEG accurately reflects coagulopathy in PPH, including hypofibrinogenemia.
• TEG's point-of-care nature allows for rapid hemorrhage evaluation and guided resuscitation.
• TEG should be considered for managing PPH and associated coagulopathy.