Prognostic Role of Initial Thromboelastography in Emergency Department Patients with Primary Postpartum Hemorrhage: Association with Massive Transfusion

TL;DR

This study shows that thromboelastography (TEG) can help predict the need for massive blood transfusions in emergency department patients with primary postpartum hemorrhage.

Contribution

The study identifies TEG's alpha angle as an early predictor of massive transfusion needs in primary postpartum hemorrhage patients.

Findings

An alpha angle < 60 degrees predicted MT with 73.5% sensitivity and 72.0% specificity.

Lactate levels and shock index > 0.9 were also independent predictors of MT.

TEG testing in the ED could improve early management of primary postpartum hemorrhage.

Abstract

Background: The early prediction of the need for massive transfusions (MTs) and the preparation of blood products are essential for managing patients with primary postpartum hemorrhage (PPH). Thromboelastography (TEG) enables a thorough evaluation of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. We investigated the role of TEG in predicting the need for MT in patients with primary PPH. Methods: A retrospective observational study was conducted in the emergency department (ED) of a university-affiliated, tertiary referral center between November 2015 and August 2023. TEG was performed upon admission. We defined MT as the requirement for transfusion of more than 10 units of packed red blood cells within the first 24 h. The primary outcome was the need for MT. Results: Among the 184 patients with initial TEG, 34 (18.5%) required MT. Except for lysis after 30 min, the MT and non-MT groups had significantly different TEG values. Based on multivariate analysis, an angle < 60 was an independent predictor of MT (odds ratio (OR) 7.769; 95% confidence interval (CI), 2.736–22.062), along with lactate (OR, 1.674; 95% CI, 1.218–2.300) and shock index > 0.9 (OR, 4.638; 95% CI, 1.784–12.056). Alpha angle < 60 degrees indicated the need for MT with 73.5% sensitivity, 72.0% specificity, and 92.3% negative predictive value. Conclusions: Point-of-care testing of TEG has the potential to be a useful tool in accurately predicting the necessity for MT in ED patients with primary PPH at an early stage.

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