Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Department of Obstetrics & Gynaecology, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Orita-Mefa, Ibadan, Nigeria.
BMC Pregnancy Childbirth. 2018 May 9;18(1):143. doi: 10.1186/s12884-018-1794-1.
Early treatment with tranexamic acid reduces deaths due to bleeding after post-partum haemorrhage. We report the prevalence of haematological, coagulation and fibrinolytic abnormalities in Nigerian women with postpartum haemorrhage.
We performed a secondary analysis of the WOMAN trial to assess laboratory data and rotational thromboelastometry (ROTEM) parameters in 167 women with postpartum haemorrhage treated at University College Hospital, Ibadan, Nigeria. We defined hyper-fibrinolysis as EXTEM maximum lysis (ML) > 15% on ROTEM. We defined coagulopathy as EXTEM clot amplitude at 5 min (A5) < 40 mm or prothrombin ratio > 1.5.
Among the study cohort, 53 (40%) women had severe anaemia (haemoglobin< 70 g/L) and 17 (13%) women had severe thrombocytopenia (platelet count < 50 × 10/L). Thirty-five women (23%) had ROTEM evidence of hyper-fibrinolysis. Based on prothrombin ratio criteria, 16 (12%) had coagulopathy. Based on EXTEM A5 criteria, 49 (34%) had coagulopathy.
Our findings suggest that, based on a convenience sample of women from a large teaching hospital in Nigeria, hyper-fibrinolysis may commonly occur in postpartum haemorrhage. Further mechanistic studies are needed to examine hyper-fibrinolysis associated with postpartum haemorrhage. Findings from such studies may optimize treatment approaches for postpartum haemorrhage.
The Woman trial was registered: NCT00872469; ISRCTN76912190 (Registration date: 22/03/2012).
产后出血后早期使用氨甲环酸可降低出血导致的死亡。我们报告了尼日利亚产后出血妇女的血液学、凝血和纤维蛋白溶解异常的流行情况。
我们对 WOMAN 试验进行了二次分析，以评估在尼日利亚伊巴丹大学教学医院治疗的 167 名产后出血妇女的实验室数据和旋转血栓弹性测定（ROTEM）参数。我们将 EXTEM 最大溶解（ML）>15%的旋转血栓弹性测定定义为高纤维蛋白溶解。我们将 EXTEM 5 分钟时的凝血酶原比率>1.5 定义为凝血障碍。
在研究队列中，53 名（40%）妇女有严重贫血（血红蛋白<70g/L），17 名（13%）妇女有严重血小板减少症（血小板计数<50×10/L）。35 名妇女（23%）有旋转血栓弹性测定高纤维蛋白溶解的证据。根据凝血酶原比率标准，16 名妇女（12%）有凝血障碍。根据 EXTEM A5 标准，49 名妇女（34%）有凝血障碍。
我们的研究结果表明，根据尼日利亚一家大型教学医院的方便样本，产后出血可能经常发生高纤维蛋白溶解。需要进一步的机制研究来检查与产后出血相关的高纤维蛋白溶解。这些研究的结果可能会优化产后出血的治疗方法。
WOMAN 试验注册：NCT00872469；ISRCTN76912190（注册日期：2012 年 3 月 22 日）。
