Authors: Zheng A et al.
Source: Journal of Clinical Anesthesia. 2025. Article 112102. DOI: 10.1016/j.jclinane.2025.112102
Summary:
In this large retrospective cohort study from a tertiary obstetric center in Lyon, Zheng and colleagues evaluated the impact of implementing thromboelastometry-guided transfusion management on fibrinogen supplementation and blood product use in women with postpartum hemorrhage (PPH). Recognizing that coagulopathy is a major determinant of maternal morbidity and mortality, the authors examined whether point-of-care viscoelastic testing could enable more precise, goal-directed hemostatic therapy.
The study analyzed 3,899 women with PPH (≥500 mL blood loss within 24 hours of delivery) across three sequential periods: a baseline era without viscoelastic testing, an intermediate period with thromboelastometry availability but no formal protocol, and a final period following implementation of a thromboelastometry-based coagulopathy management protocol. The primary outcome was fibrinogen concentrate administration, with secondary outcomes including transfusion of red blood cells, plasma, and platelets within the first 24 hours.
Both the availability of thromboelastometry alone and the subsequent implementation of a structured protocol were independently associated with reduced fibrinogen concentrate use, with the largest effect observed after protocol implementation. Importantly, the protocol period was also associated with substantial reductions in transfusion of red blood cells, fresh frozen plasma, and platelets. These changes occurred without an increase in massive PPH (≥2500 mL blood loss), suggesting that transfusion restraint was not achieved at the expense of hemorrhage control.
The findings support the concept that viscoelastic-guided algorithms can improve precision in obstetric hemorrhage management, reducing empiric or prophylactic factor replacement and blood product exposure while maintaining clinical safety. The authors note that further work is needed to clarify downstream maternal outcomes and economic implications.
What You Should Know:
• Coagulopathy drives prognosis in postpartum hemorrhage, making early targeted therapy critical.
• Thromboelastometry enables real-time, goal-directed assessment of hemostasis at the bedside.
• Protocolized viscoelastic-guided management can substantially reduce fibrinogen and blood product use.
• Reduced transfusion was achieved without increasing progression to massive hemorrhage.
Key Points:
• Implementation of a thromboelastometry-guided protocol reduced fibrinogen concentrate use by more than 80%.
• Red blood cell, plasma, and platelet transfusions were all significantly reduced after protocol adoption.
• Availability of thromboelastometry alone helped, but protocolization provided the greatest benefit.
• These data support structured viscoelastic-guided algorithms in obstetric hemorrhage care.
Thank you to the Journal of Clinical Anesthesia for publishing this important contribution highlighting the clinical value of thromboelastometry-guided transfusion strategies in postpartum hemorrhage.