Impact of ROTEM on transfusion strategy in the management of coagulopathy during postpartum hemorrhage ≥1000 mL: a matched pre-post study.

BACKGROUND

Rotational thromboelastometry (ROTEM) provides rapid, point-of-care coagulation data. However, the specific effect of its use for coagulopathy management on blood component transfusions during severe postpartum hemorrhage remains undetermined. We aimed to assess whether the use of ROTEM was associated with reduced administration of hemostatic blood products and blood transfusions in women with postpartum hemorrhage ≥1000 mL.

METHODS

In this single-center retrospective pre-post matched study, administration of hemostatic blood products and packed red blood cells was compared in two groups of adult patients with postpartum hemorrhage ≥1000 mL. The Control group consisted of patients managed empirically or based on laboratory results between 2016 and 2018. The ROTEM group consisted of patients managed using a ROTEM-guided coagulopathy protocol between 2021 and 2023. Exact matching was applied for qualitative variables, and propensity score matching was used for quantitative variables. A 1:1 matching procedure was performed using 14 confounders. Odds ratios were estimated using conditional logistic regression.

RESULTS

After matching, 102 patients were included in each group. ROTEM use was associated with significantly lower transfusion rates of any hemostatic blood product (25% vs. 38%; OR: 0.46 [95% CI: 0.22 to 0.94]), fibrinogen concentrates (25% vs. 37%; OR: 0.48 [95% CI: 0.23-0.98]), fresh frozen plasma (3% vs. 17%; OR: 0.13 [95% CI: 0.03-0.54], and packed red blood cells (29% vs. 49%; OR: 0.38 [95% CI: 0.19-0.73]).

CONCLUSIONS

The use of ROTEM to manage hemostatic impairment in postpartum hemorrhage ≥1000 mL was associated with a significant reduction in the transfusion of hemostatic blood products and red blood cells.