Liew-Spilger Alyson E, Sorg Nikki R, Brenner Toby J, Langford Jack H, Berquist Margaret, Mark Natalie M, Moore Spencer H, Mark Julie, Baumgartner Sara, Abernathy Mary P
Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA.
Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA.
J Clin Med. 2021 Aug 31;10(17):3946. doi: 10.3390/jcm10173946.
This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.
本文讨论了粘弹性止血检测（VHA）在评估产后出血（PPH）患者止血能力和指导血液成分治疗（BCT）方面的重要性和有效性。近年来，血栓弹力图和旋转血栓弹力测定等VHA越来越多地用于指导PPH患者的BCT、止血辅助治疗和促止血药物治疗。识别止血能力的三大支柱包括临床观察、常规凝血检测和VHA。VHA具有优势，因为它们能评估凝血全过程中血液所有成分的累积作用，周转时间快，且是可连续进行的即时检验。尽管有这些优势，但由于对正确技术和结果解读的理解不足、广泛标准化的缺乏以及大型临床试验的缺乏，VHA的使用未得到充分利用。这些VHA还可用于子宫收缩乏力、子痫前期、妊娠急性脂肪肝、羊水栓塞、胎盘早剥、生殖道创伤、手术创伤以及遗传性和产前获得性凝血病的情况。迫切需要一种即时检验，能够为产科医生提供有关凝血病变状态的快速结果。VHA在预测和治疗PPH方面的应用虽然尚处于初期阶段，但可以满足这一需求。
