Point-of-care testing for diagnosing hypofibrinogenemia in postpartum hemorrhage: Systematic review and meta-analysis

Background

Postpartum hemorrhage (PPH) can rapidly cause hypofibrinogenemia, requiring prompt coagulation factor replacement. Point-of-care testing (POCT) is gaining interest for early diagnosis for hypofibrinogenemia, despite limited evidence. This systematic review evaluated the diagnostic accuracy of POCT for hypofibrinogenemia in PPH.

Materials and methods

A literature search was conducted using MEDLINE, Embase, Cochrane, and Web of Science. Studies using POCT for PPH diagnosis, both observational and interventional, were included. Risk of bias was assessed using the QUADAS-2 tool. A meta-analysis was performed using the Reitsma bivariate random-effects model for three POCT types: dry hematology, thromboelastography, and thromboelastometry. The diagnostic accuracy was evaluated using a summary Receiver Operating Characteristic (ROC) curve and area under the curve (AUC).

Results

Nine articles, including 16 studies with a total of 2902 patients, were analyzed. The dry hematology group had only two studies, preventing data pooling. Thromboelastography (4 articles, including 10 studies with 1386 patients) showed a sensitivity of 0.80 (95 % CI: 0.75–0.84), specificity of 0.90 (0.85–0.93), and AUC of 0.81 (0.77–0.85). Thromboelastometry (4 articles, including 4 studies with 1394 patients) showed a sensitivity of 0.89 (0.74–0.96), specificity of 0.84 (0.63–0.94), and AUC of 0.93 (0.83–0.95).

Conclusions

Thromboelastography and thromboelastometry demonstrated high diagnostic accuracy for hypofibrinogenemia in PPH. However, evidence for dry hematology was insufficient. POCT may enable rapid and accurate diagnosis of hypofibrinogenemia in PPH.