Factor <scp>XIII</scp> Supplementation in Postpartum Hemorrhage: From Biological Rationale to Clinical Implementation

Postpartum hemorrhage (PPH) remains the leading cause of preventable maternal mortality despite standard interventions. Recent fibrinogen trials failed to improve outcomes, prompting interest in coagulation factor XIII (FXIII). FXIII functions as "molecular cement," cross-linking fibrin and stabilizing clots. During pregnancy, FXIII activity decreases 20%-30%, with further depletion during PPH. Observational studies show low antepartum FXIII predicts bleeding risk, while ex vivo supplementation restores clot firmness. The SWIFT trial (NCT06481995) represents the first randomized controlled trial evaluating early FXIII supplementation in PPH. Although implementation challenges are significant (diagnostic accessibility, thrombotic monitoring, supply constraints), even modest hemostatic improvements could substantially reduce maternal mortality.

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Publication Details

Journal
American Journal of Hematology
Published
2025-12-31
DOI
https://doi.org/10.1002/ajh.70181
Primary Topic
Blood properties and coagulation
Type
article
Field-Weighted Citation Impact
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article

Factor XIII Supplementation in Postpartum Hemorrhage: From Biological Rationale to Clinical Implementation

Jennifer S. Woo, Jeremy W. Jacobs, Brian D. Adkins, Victoria Costa et al.
American Journal of Hematology
Blood properties and coagulation
article

Factor XIII Supplementation in Postpartum Hemorrhage: From Biological Rationale to Clinical Implementation

Jennifer S. Woo, Jeremy W. Jacobs, Brian D. Adkins, Victoria Costa, Garrett S. Booth, Allison P. Wheeler, Sheharyar Raza, Michelle Simon, Elizabeth A. Abels
article en

Abstract

Postpartum hemorrhage (PPH) remains the leading cause of preventable maternal mortality despite standard interventions. Recent fibrinogen trials failed to improve outcomes, prompting interest in coagulation factor XIII (FXIII). FXIII functions as "molecular cement," cross-linking fibrin and stabilizing clots. During pregnancy, FXIII activity decreases 20%-30%, with further depletion during PPH. Observational studies show low antepartum FXIII predicts bleeding risk, while ex vivo supplementation restores clot firmness. The SWIFT trial (NCT06481995) represents the first randomized controlled trial evaluating early FXIII supplementation in PPH. Although implementation challenges are significant (diagnostic accessibility, thrombotic monitoring, supply constraints), even modest hemostatic improvements could substantially reduce maternal mortality.

American Journal of HematologyVol. 101(4)
City Of Hope National Medical Center (US), University of Toronto (CA), Vanderbilt University (US), University of Washington Medical Center (US), Yale University (US), Washington Center (US), The University of Texas Health Science Center (US), New York University (US), The University of Texas Southwestern Medical Center (US), Vanderbilt University Medical Center (US), Canadian Blood Services (CA)
Good health and well-being
Openalex Percentile: Top 27%
Blood properties and coagulation
DOIOpen Access PDFOpenAlex
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