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Concentrado de fibrinogénio na hemorragia pós-parto : uma revisão narrativa da literatura
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A Hemorragia Pós-Parto (HPP), é uma importante causa de mortalidade e morbilidade materna a nível mundial, sendo responsável por um terço das mortes maternas. Embora a mortalidade por esta causa tenha vindo a diminuir, o número de casos de hemorragia pósparto tem vindo a aumentar. Perante uma hemorragia, o fibrinogénio é o primeiro fator da coagulação a diminuir. A sua reposição pode ser feita através da administração de plasma fresco congelado (PFC), crioprecipitado ou concentrado de fibrinogénio (CF). Este último apresenta claras vantagens, especialmente em situações de emergência. Tem vindo assim a crescer o interesse neste produto, tendo em conta as suas propriedades no que respeita ao restabelecimento da hemóstase. Esta revisão narrativa da literatura pretende rever a potencial eficácia e segurança do uso de CF na HPP, incluindo todos os estudos clínicos publicados nos últimos 10 anos incluindo os termos MeSH: postpartum haemorraghe, fibrinogen, fibrinogen concentrate. Dos oito estudos englobados, seis são retrospetivos e, na sua maioria, com populações reduzidas, limitando as conclusões dos mesmos. Globalmente, constataram que o uso de CF, especialmente quando administrado precocemente a mulheres com HPP e fibrinogénio plasmático < 2 g/L, associa-se a menores perdas hemorrágicas, a aumentos superiores na concentração sérica de fibrinogénio com volumes de produto administrado inferiores aos necessários para atingir a mesma concentração usando crioprecipitado ou PFC. A administração de CF está ainda associada à diminuição das necessidades de transfusões de concentrados eritrocitários, plaquetários e de PFC, o que por si só diminui o risco de complicações infeciosas e associados à hipervolémia. Não foram sido evidenciados efeitos adversos relevantes. Conclui-se assim, apesar da evidência de baixa qualidade, que há uma tendência positiva associada à administração de CF, nestas circunstâncias, no que concerne à sua eficácia e segurança, que deverá ser comprovada com estudos mais robustos que urgem ser realizados.
Postpartum hemorrhage (PPH) is an important cause of maternal mortality and morbidity worldwide, as it is responsible for one-third of maternal deaths. Although deaths related to PPH are decreasing, the number of cases is soaring. The first coagulation factor achieves critical levels during an active hemorrhage is fibrinogen. Its reposition can be done by the administration of fresh frozen plasma (FFP), cryoprecipitate or fibrinogen concentrate (FC). FC has several advantages over the others especially in an emergency because of their proprieties and capacity in reestablishing the hemostasis. Due to this fact, the interest in this product is growing. This narrative review of the literature includes all the clinical studies published in the last 10 years in MEDLINE gathering by the following MeSH terms: fibrinogen concentrate, postpartum hemorrhage, fibrinogen. The goal was to find out if the use of FC in the context of PPH is efficient and safe. Six of the eight studies included are retrospective and most of them have a small population which limits the conclusions. In general, they conclude that the use of FC in PPH situations associated with fibrinogen levels < 2 g/L, can reduce blood loss and can also reach higher concentrations of plasma fibrinogen comparing to the use of the same dose of FFP or cryoprecipitate. It is also associated with fewer transfusions of FFP, erythrocytes and plaquettes concentrate, which decreases the risk of complications associated with infections and hypervolemia just by itself. There are no reports of severe adverse events. Concluding, besides the low-quality evidence, there is a tendency towards the efficacy and safety of FC administration in these situations however, there is a clear need for better quality clinical trials.
Postpartum hemorrhage (PPH) is an important cause of maternal mortality and morbidity worldwide, as it is responsible for one-third of maternal deaths. Although deaths related to PPH are decreasing, the number of cases is soaring. The first coagulation factor achieves critical levels during an active hemorrhage is fibrinogen. Its reposition can be done by the administration of fresh frozen plasma (FFP), cryoprecipitate or fibrinogen concentrate (FC). FC has several advantages over the others especially in an emergency because of their proprieties and capacity in reestablishing the hemostasis. Due to this fact, the interest in this product is growing. This narrative review of the literature includes all the clinical studies published in the last 10 years in MEDLINE gathering by the following MeSH terms: fibrinogen concentrate, postpartum hemorrhage, fibrinogen. The goal was to find out if the use of FC in the context of PPH is efficient and safe. Six of the eight studies included are retrospective and most of them have a small population which limits the conclusions. In general, they conclude that the use of FC in PPH situations associated with fibrinogen levels < 2 g/L, can reduce blood loss and can also reach higher concentrations of plasma fibrinogen comparing to the use of the same dose of FFP or cryoprecipitate. It is also associated with fewer transfusions of FFP, erythrocytes and plaquettes concentrate, which decreases the risk of complications associated with infections and hypervolemia just by itself. There are no reports of severe adverse events. Concluding, besides the low-quality evidence, there is a tendency towards the efficacy and safety of FC administration in these situations however, there is a clear need for better quality clinical trials.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Fibrinogénio Hemorragia pós-parto Transfusão Concentrado de fibrinogénio Coagulopatia