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The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review
BACKGROUND: The utility of instantaneous evaluation of coagulation during primary postpartum haemorrhage (PPH) is paramount in the context of empirical blood product transfusion-related risk of dilutional and consumptive coagulopathy and circulatory overload. METHODS: A profound screening of electro...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10077780/ https://www.ncbi.nlm.nih.gov/pubmed/37032697 http://dx.doi.org/10.4103/sja.sja_529_22 |
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author | Khanna, Puneet Sinha, Chandni Singh, Akhil K. Kumar, Ajeet Sarkar, Soumya |
author_facet | Khanna, Puneet Sinha, Chandni Singh, Akhil K. Kumar, Ajeet Sarkar, Soumya |
author_sort | Khanna, Puneet |
collection | PubMed |
description | BACKGROUND: The utility of instantaneous evaluation of coagulation during primary postpartum haemorrhage (PPH) is paramount in the context of empirical blood product transfusion-related risk of dilutional and consumptive coagulopathy and circulatory overload. METHODS: A profound screening of electronic databases till August 15, 2022 was carried out after being enlisted in PROSPERO (CRD42021275514). Randomized control studies, comparative cohort studies, and cross-sectional studies comparing point-of-care viscoelastic test guided blood product transfusion with empirical transfusion in patients with PPH were included. RESULTS: We retrieved five studies, with a total of 1914 parturient with PPH. Patients receiving transfusion based upon point of care viscoelastic tests had lesser risk of having emergency hysterectomy (Odds ratio (OR) = 0.55, 95% CI 0.32–0.95, I(2) = 7%), transfusion-associated circulatory overload (TACO) (OR = 0.03, 95% CI 0.00–0.50), reduced transfusion of fresh frozen plasma (OR = 0.07, 95% CI 0.04–0.14, I(2) = 89%), platelets (OR = 0.51, 95% CI 0.28–0.91, I(2) = 89%), packed red blood cell transfusion (OR = 0.70, 95% CI 0.55–0.88, I(2) = 89%), and had better cost-effective treatment [Mean difference (MD) = −357.5, 95% CI − 567.75 to −147.25, I(2) = 93%] than patient received empirical transfusion. However, there was no significant difference in the requirement of ICU admissions (OR = 0.77, 95% CI = 0.46–1.29, I(2) = 82%). No mortality was detected across the studies. CONCLUSIONS: Point of care viscoelastic assessment guided transfusion in PPH confederates with reduced morbidity. Nevertheless, more studies on the triggering values for transfusion, long-term survival, and cost-benefit in patients with PPH are warranted to establish its utility. |
format | Online Article Text |
id | pubmed-10077780 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-100777802023-04-07 The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review Khanna, Puneet Sinha, Chandni Singh, Akhil K. Kumar, Ajeet Sarkar, Soumya Saudi J Anaesth Original Article BACKGROUND: The utility of instantaneous evaluation of coagulation during primary postpartum haemorrhage (PPH) is paramount in the context of empirical blood product transfusion-related risk of dilutional and consumptive coagulopathy and circulatory overload. METHODS: A profound screening of electronic databases till August 15, 2022 was carried out after being enlisted in PROSPERO (CRD42021275514). Randomized control studies, comparative cohort studies, and cross-sectional studies comparing point-of-care viscoelastic test guided blood product transfusion with empirical transfusion in patients with PPH were included. RESULTS: We retrieved five studies, with a total of 1914 parturient with PPH. Patients receiving transfusion based upon point of care viscoelastic tests had lesser risk of having emergency hysterectomy (Odds ratio (OR) = 0.55, 95% CI 0.32–0.95, I(2) = 7%), transfusion-associated circulatory overload (TACO) (OR = 0.03, 95% CI 0.00–0.50), reduced transfusion of fresh frozen plasma (OR = 0.07, 95% CI 0.04–0.14, I(2) = 89%), platelets (OR = 0.51, 95% CI 0.28–0.91, I(2) = 89%), packed red blood cell transfusion (OR = 0.70, 95% CI 0.55–0.88, I(2) = 89%), and had better cost-effective treatment [Mean difference (MD) = −357.5, 95% CI − 567.75 to −147.25, I(2) = 93%] than patient received empirical transfusion. However, there was no significant difference in the requirement of ICU admissions (OR = 0.77, 95% CI = 0.46–1.29, I(2) = 82%). No mortality was detected across the studies. CONCLUSIONS: Point of care viscoelastic assessment guided transfusion in PPH confederates with reduced morbidity. Nevertheless, more studies on the triggering values for transfusion, long-term survival, and cost-benefit in patients with PPH are warranted to establish its utility. Wolters Kluwer - Medknow 2023 2023-01-02 /pmc/articles/PMC10077780/ /pubmed/37032697 http://dx.doi.org/10.4103/sja.sja_529_22 Text en Copyright: © 2023 Saudi Journal of Anesthesia https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Khanna, Puneet Sinha, Chandni Singh, Akhil K. Kumar, Ajeet Sarkar, Soumya The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review |
title | The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review |
title_full | The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review |
title_fullStr | The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review |
title_full_unstemmed | The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review |
title_short | The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review |
title_sort | role of point of care thromboelastography (teg) and thromboelastometry (rotem) in management of primary postpartum haemorrhage: a meta-analysis and systematic review |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10077780/ https://www.ncbi.nlm.nih.gov/pubmed/37032697 http://dx.doi.org/10.4103/sja.sja_529_22 |
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