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Functional Fibrinogen in Pregnancy
Abstract Number: F-29
Abstract Type: Original Research
Background:The management of obstetric hemorrhage is complex, and is currently one of the leading causes of anesthesiology malpractice claims.1 One of the best predictors of severity of hemorrhage as well as progression to more severe hemorrhage is the fibrinogen level, which is normally markedly higher in the parturient.2 These lab assessments, however, can have a long turnaround time, which limits their ability to guide clinical decisions at the time of the hemorrhagic event. Point of Care (POC) testing may be a way around this issue, as test results can be run in the operating room and interpreted in real time without any lab delays. Thromboelastography is one such test, which can be run to specifically measure clinical fibrinogen levels using the functional fibrinogen assay. This assay, however, has not been tested or verified in the parturient where baseline coagulation is abnormal. We therefore set out to examine this relationship.
Materials and Methods: 50 patients presenting to the labor floor for otherwise indicated coagulation testing were recruited. In addition to traditional tests such as Clauss fibrinogen assays, a separate coagulation tube was drawn for analysis via traditional thromboelastography and functional fibrinogen. Relationships between functional fibrinogen level, Clauss fibrinogen level, maximum amplitude, and platelet count were examined using Pearson correlation and simple linear regression.
Results: The most common indication for fibrinogen analysis was for [N(%)] rule out pre-eclampsia [26 (52)], followed by reassessment of confirmed pre-eclampsia [14 (28)], and hemorrhage [8 (16)]. Most patients were in their third trimester [41 (82)]. Both the functional fibrinogen and functional fibrinogen MA were highly correlated with the Clauss assay (R=0.891 p=0.00, R=0.872 p=0.00). Regression analysis confirmed the correlation as well with an R2= 0.795, a coefficient of 0.849 (p=0.00) and a constant of 115.53 (p=0.00). A regression analysis to determine the effect of platelet count on the difference for functional fibrinogen measurements was not significant (R2= 0.16 p=0.38). A regression analysis to determine the effect of kaolin MA on functional fibrinogen levels revealed the presence of correlation R=0.604, R2=0.365 (p=0.00), demonstrating the contribution of fibrinogen to the kaolin MA measurement.
Conclusion: POC functional fibrinogen assays are a potential substitute for formal Clauss fibrinogen in the pregnant population.
1. Dutton et al. Massive hemorrhage: a report from the anesthesia closed claims project. Anesthesiology 2014;121:450–8
2. Collis RE, Collins PW. Haemostatic management of obstetric haemorrhage. Anaesthesia 2015;70 Suppl 1:78-e28