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

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.