Impact of implementing a thromboelastometry-guided transfusion strategy on fibrinogen supplementation and transfusion in women with postpartum hemorrhage
Authors' conclusion
Implementing a thromboelastometry-guided protocol was associated with significantly reduced use of fibrinogen concentrate, red blood cells, fresh frozen plasma, and platelet concentrates, without increasing the risk of progression to massive hemorrhage.
Study context
- Population
- Adult women with PPH (≥500 mL blood loss within 24 h postpartum) at gestational age ≥ 22 weeks, tertiary obstetric unit, university hospital, Lyon, Franceanalysed
- Participants
- 3,899 women
- Exposure
- Thromboelastometry-based coagulopathy management protocol (Period 3) or thromboelastometry available (Period 2) vs no viscoelastic test (Period 1)
- Outcome
- Proportion of patients receiving fibrinogen concentrate in each period
Methodological detailssingle-centre, before-after (three periods), multivariable adjusted (bidirectional stepwise regression, 12 preselected confounders)
- Single-centre
- Before-after (three periods)
- Multivariable adjusted (bidirectional stepwise regression, 12 preselected confounders)
Main finding
As reported in the abstract
Fibrinogen concentrate administration
Each group vs period 1Adjusted odds ratio (95 % CI)
Period 3
0.19(0.14–0.28)
Period 2
0.70(0.50–0.98)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aOR (95 % CI) | |
|---|---|---|
| RBC transfusion within first 24 hPeriod 3 vs Period 1 | 0.25 (0.19–0.33) | |
| FFP transfusion within first 24 hPeriod 3 vs Period 1 | 0.17 (0.09–0.33) | |
| Platelet concentrate transfusion within first 24 hPeriod 3 vs Period 1 | 0.23 (0.08–0.62) | |
| 0.050.21520Adjusted odds ratio (log scale) |
Safety
Massive PPH (≥2500 mL)
- Frequency did not change significantly across the three periods
Original publication
Impact of implementing a thromboelastometry-guided transfusion strategy on fibrinogen supplementation and transfusion in women with postpartum hemorrhage. J Clin Anesth. Published 12 December 2025. doi:10.
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