Fresh frozen plasma, fibrinogen concentrate, and antithrombin concentrate administration for obstetrical disseminated intravascular coagulation by the Japanese previous and new criteria

Abstract

Aim: The purpose of this study is to clarify the frequencies of fresh frozen plasma (FFP) ± fibrinogen concentrate administration (fibrinogen concentrate [FC] therapy) and antithrombin (AT) concentrate administration (AT therapy) for the women with obstetrical disseminated intravascular coagulation (DIC).

Methods: Two retrospective multicenter case-control studies as Study-1 (January-December 2018) and Study-2 (July 2022-June 2023) were conducted. Study-1 was the historical control of Study-2. All participants experienced a blood loss of ≥1000 mL during vaginal delivery or ≥2000 mL during cesarean section. All participants were subsequently assigned to the DIC group or non-DIC group.

Results: Study-1 comprised 175 women (obstetrical DIC, 27; control, 148; by the previous criteria) and Study-2 comprised 175 women (obstetrical DIC, 9; control, 166; by the new criteria). The frequencies of FFP (±FC therapy) or FC therapy in DIC group were significantly higher than non-DIC group in Study-1 (88.9% vs. 25.0%, 44.4% vs. 4.0%) and Study-2 (100% vs. 24.7%, 77.8% vs. 5.4%); however, the frequencies of AT therapy were similar. Furthermore, in the DIC group, all women with fibrinogen <150 mg/dL received FFP ± FC therapy in Study-1 (n = 19) and Study-2 (n = 8); however, those with AT activity <70% received AT therapy (16.7% [4/24] and 12.5% [1/8], respectively).

Conclusion: We revealed an association between the high frequency of FFP ± FC therapy and lower fibrinogen levels, but a low frequency of AT therapy regardless of AT activity, in obstetrical DIC regardless of diagnosis criteria.

Keywords: antithrombin concentrate; fibrinogen concentrate; fresh frozen plasma; obstetrical disseminated intravascular coagulation; postpartum hemorrhage.