The purpose of the study is to find out if the regimen of prothrombin complex concentrate (PCC) together with fibrinogen concentrate is as efficient as fresh frozen plasma (FFP) (plus fibrinogen if needed) during the early stages of the transfusion therapy in postpartum haemorrhage (PPH). The original protocol included the use of HES and the recruitment of patients was postponed while waiting the final decision by EMA. All HES solutions were abandoned at our institution in September and an amendment was made to change the protocol. HES solution are replaced by the use of hyperoncotic (20%) albumin.
Forty patients are randomized to receive either PCC and fibrinogen concentrate (PCC group) or FFP (and fibrinogen if needed) (FFP group), 20 patients in each group. Patients in the PCC group receive 15 IU/kg of PCC concentrate and 2 g of fibrinogen concentrate. Patients in the FFP group receive 4 units of FFP. In both groups, additional fibrinogen is administered (if needed) to increase the baseline FIBTEM-MCF (at 5 min) to the target of 15 mm. Baseline blood samples will be drawn at study inclusion when the (on-going) blood loss exceeds 1500 ml. The next samples will be drawn at 45 min (or immediately after the administration of the study drug if later). Otherwise, the management protocol strictly follows the local PPH guideline. The primary endpoint is the amount of blood loss within the first 6 and 24 hours after delivery. Secondary endpoints include the difference/similarity in the laboratory determinations (ia coagulation screen, PFA-100, CAT and ROTEM).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Maternity Hospital, Helsinki University Central Hospital
Helsinki, Uusimaa, Finland
Blood loss
The suctioned blood is recorded and sponges, wraps, swabs, etc. are carefully weighed. The amount of blood loss will be compared between the groups.
Time frame: Within the first 6 and 24 hours after delivery
Maximum clot firmness (MCF)
INTEM, EXTEM, FIBTEM and APTEM / ROTEM
Time frame: At the time when the blood loss exceeds 1500 ml and 45 min later
Endogenous thrombin potential
CAT
Time frame: At the time when the blood loss exceeds 1500 ml and 45 min later
Fibrinogen level
Clauss method
Time frame: At the time when the blood loss exceeds 1500 ml and 45 min later
Platelet function
PFA-100
Time frame: At the time when the blood loss exceeds 1500 ml and 45 min later
Clotting time (CT)
INTEM, EXTEM, FIBTEM and APTEM / ROTEM
Time frame: At the time when the blood loss exceeds 1500 ml and 45 min later
Clot formation time (CFT)
INTEM, EXTEM, FIBTEM and APTEM / ROTEM
Time frame: At the time when the blood loss exceeds 1500 ml and 45 min later
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