Frevert M L, Bürgi J, Brun R, Hothorn T, Rösslein M, Ochsenbein-Kölble N, Haslinger C, Korte W
Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland.
Center for Laboratory Medicine, Hemostasis and Hemophilia Center, St. Gallen, Switzerland.
Arch Gynecol Obstet. 2025 Mar;311(3):585-590. doi: 10.1007/s00404-024-07799-2. Epub 2024 Nov 4.
The role of factor XIII in acute bleeding situations is gaining more and more importance. It has previously been shown that prepartum factor XIII activity has a significant impact on postpartum blood loss. Whether factor XIII antigen behaves in a similar manner is unknown. As postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality worldwide and factor XIII antigen determination might be available more readily in some centers as compared to factor XIII activity, this is an important question to answer, especially in the emergency situation of a postpartum hemorrhage.
To assess the correlation of prepartum factor XIII antigen with prepartum factor XIII activity and to evaluate the correlation between prepartum factor XIII antigen on measured postpartum blood loss.
This is a secondary analysis of a prospective cohort study which analyzed the impact of prepartum blood coagulation factor XIII activity on postpartum blood loss in 1300 women at the University Hospital Zurich, Switzerland between October 2015 and November 2016 ("PPH-1300 study"). Blood loss was quantified using a previously validated technique. The association of factor XIII activity and factor XIII antigen was assessed by means of a Spearman rank correlation and differences were displayed using Bland-Altman plot and Passing-Bablok regression. The effect of the prepartum factor XIII antigen on blood loss was estimated by continuous outcome logistic regression.
Prepartum factor XIII activity significantly correlated with prepartum factor XIII antigen (Spearman rank correlation coefficient for prepartum values 0.89, p < 0.001 and postpartum values 0.902, p < 0.001). Elevated values of prepartum factor XIII antigen showed a trend toward lower measured postpartum blood loss.
The correlation of factor XIII activity with factor XIII antigen (subunit A) in a large real-world sample as well as an association of prepartum factor XIII antigen and postpartum blood loss is observed. Factor XIII antigen determination, a highly automatable test, could be useful in emergency situations such as a PPH (as well as other bleeding situations) if the determination of factor XIII activity is not possible. To evaluate whether FXIII replenishment reduces blood loss is the focus of ongoing studies.
凝血因子 XIII 在急性出血情况下的作用日益重要。此前已有研究表明，产前凝血因子 XIII 活性对产后失血有显著影响。凝血因子 XIII 抗原是否也有类似表现尚不清楚。由于产后出血是全球孕产妇发病和死亡的主要原因之一，而且在某些中心，与凝血因子 XIII 活性检测相比，凝血因子 XIII 抗原检测可能更容易实现，因此这是一个需要回答的重要问题，尤其是在产后出血的紧急情况下。
评估产前凝血因子 XIII 抗原与产前凝血因子 XIII 活性之间的相关性，并评估产前凝血因子 XIII 抗原与产后实测失血量之间的相关性。
这是一项前瞻性队列研究的二次分析，该研究分析了 2015 年 10 月至 2016 年 11 月期间瑞士苏黎世大学医院 1300 名女性的产前凝血因子 XIII 活性对产后失血的影响（“PPH - 1300 研究”）。使用先前验证的技术对失血量进行量化。通过 Spearman 等级相关性评估凝血因子 XIII 活性与凝血因子 XIII 抗原之间的关联，并使用 Bland - Altman 图和 Passing - Bablok 回归展示差异。通过连续结果逻辑回归估计产前凝血因子 XIII 抗原对失血量的影响。
产前凝血因子 XIII 活性与产前凝血因子 XIII 抗原显著相关（产前值的 Spearman 等级相关系数为 0.89，p < 0.001；产后值为 0.902，p < 0.001）。产前凝血因子 XIII 抗原值升高显示出产后实测失血量降低的趋势。
在一个大型真实世界样本中观察到了凝血因子 XIII 活性与凝血因子 XIII 抗原（亚基 A）之间的相关性，以及产前凝血因子 XIII 抗原与产后失血之间的关联。如果无法检测凝血因子 XIII 活性，凝血因子 XIII 抗原检测（一种高度可自动化的检测方法）在产后出血（以及其他出血情况）等紧急情况下可能会有用。评估补充凝血因子 XIII 是否能减少失血量是正在进行的研究重点。
