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Use of clotting factors and other prohemostatic drugs for obstetric hemorrhage

Mercier, Frédéric Ja; Bonnet, Marie-Pierreb,c

Current Opinion in Anesthesiology: June 2010 - Volume 23 - Issue 3 - p 310–316
doi: 10.1097/ACO.0b013e32833835a2
Obstetric and gynecological anaesthesia: Edited by Giorgio Capogna

Purpose of review To guide the optimal use of blood products and to clarify the indications for prohemostatic drugs in obstetric hemorrhage.

Recent findings The literature emphasizes the usefulness of transfusing packed red blood cells, fresh frozen plasma and platelets earlier and in defined ratios to prevent dilutional coagulopathy during obstetric hemorrhage. The value of fibrinogen concentrate and prohemostatic drugs such as tranexamic acid and recombinant factor VIIa is also pointed out.

Summary It seems reasonable to use blood products for transfusion earlier and in a 1: 1 fresh frozen plasma: red blood cell ratio during acute obstetric hemorrhage; however, this analysis is mainly based on trauma literature. Fibrinogen concentrate should be added if the fibrinogen plasma level remains below 1.0 g l−1 and perhaps even as soon as it falls below 1.5–2.0 g l−1; the addition of tranexamic acid (1 g) is cheap, likely to be useful and appears safe. Data on the proactive administration of platelets are insufficient to recommend this practice routinely. Presently, recombinant factor VIIa (60–90 μg kg−1) is advocated only after failure of other conventional therapies, including embolization or conservative surgery, but prior to obstetric hysterectomy. Prospective randomized controlled trials are highly desirable.

aDépartement d'Anesthésie Réanimation, Hôpital Antoine Béclère, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Clamart, France

bDépartement d'Anesthésie Réanimation, Maternité Port Royal, Hôpital Cochin, Groupement Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, Université Paris V – René Descartes, France

cINSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Paris VI, Paris, France

Correspondence to Frédéric J. Mercier, Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, 92141 Clamart Cedex BP 405, France Tel: +33 1 45 37 42 73; fax: +33 1 45 37 49 85; e-mail: frederic.mercier@abc.aphp.fr

© 2010 Lippincott Williams & Wilkins, Inc.