Hematology/Oncology

PE Workup in Pregnancy – YEARS, Wells, Both, Neither?

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Pregnant patients who present with signs and symptoms concerning for PE can be safely evaluated using Wells criteria or the YEARS algorithm. 

Source
Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. J Thromb Haemost. 2023 Mar;21(3):606-615. doi: 10.1016/j.jtha.2022.11.025. Epub 2022 Dec 22.

PROCOAG RCT – Early PCC for Trauma Patients at Risk of Massive Transfusion

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This well-designed RCT finds early administration of 4-factor prothrombin complex concentrate (PCC) to patients at risk of receiving massive transfusion protocol (MTP) did not reduce 24-hour blood product consumption or mortality but did increase thrombotic events.

Source
Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. JAMA. 2023 Mar 21. doi: 10.1001/jama.2023.4080. Online ahead of print.

How to Manage Postpartum Hemorrhage

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Postpartum hemorrhage is defined as ≥1000mL of blood loss irrespective of the delivery route, with associated shock. Remember the four “T’s”: tone (uterine atony), trauma (lacerations, uterine rupture), tissue (retained placenta, clots) and thrombin (coagulopathies). Manage the ABCs (especially two large bore IV’s for massive transfusion) and tailor treatment to the specific cause. Recommendations for balanced transfusion are derived from the trauma literature, but it is important to administer cryoprecipitate earlier to maintain a higher fibrinogen level (at term the normal level is >350mg/dL).

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