Fibrinogen concentrates for post-partum haemorrhage? Do not miss the most relevant population!

摘要

Post-partum haemorrhage (PPH) is an emotional clinical event leading to high morbidity and mortality in obstetrics. Among others, delayed availability of blood products has been identified as contributing to adverse outcomes. To reduce the requirements of transfusion, several new approaches have been suggested during PPH. Administration of fibrinogen concentrates for prevention or treatment of bleeding is increasingly being supported, even if evidence-based data are still lacking. Fibrinogen has been shown to be the first coagulation factor to decrease to critical levels in actively bleeding patients. The decrease is correlated with the volume of blood loss. The trigger level for supplementation has been increased in recent guidelines on severe bleeding. Clot strength increases with fibrinogen level over a wide range of values, from 0 to 9.5 g litre V An in vitro model has suggested a plasma level as high as 2.5 g litre-1 to optimise coagulation altered by a dilution coagulopathy.8At term, parturients already exhibits a higher level of fibrinogen compared with non-pregnant women. During PPH, a fibrinogen level <2 g litre"1 has been shown to predict progression to more severe bleeding or the need for a haemostatic intervention, although even higher levels have been suggested. Anecdotal uncontrolled reports in obstetrics have suggested an improved haemostasis associated with administration of fibrinogen concentrates.