Fibrin clot properties among women with endometriosis and the impact of ovarian stimulation

The Utility of Total Thrombus-Formation Analysis System (T-TAS) in the Thrombosis and Hemostasis Field: A Scoping Review

BACKGROUND

A wide variety of laboratory hemostasis tests is available, but the majority is plasma-based, static and unable to assess platelet function and fibrin formation simultaneously. The Total Thrombus-Formation Analysis System (T-TAS) is a microchip-based flow chamber system that simulates in vivo conditions for evaluating whole blood thrombogenicity.

AIM

A comprehensive overview of its applicability in different thrombosis and hemostasis related clinical situations is lacking and therefore this scoping review was performed.

MATERIALS & METHODS

A literature search was done using the electronic databases PubMed, Scopus and Embase on January 7, 2024. Original studies assessing the usefulness of the T-TAS in thrombosis and hemostasis related clinical situations were eligible for this scoping review.

RESULTS

A total of 28 studies were included; six studies investigating the role of the T-TAS in congenital bleeding disorders, five studies using the T-TAS to assess 1-year bleeding risk in patients on antiplatelet or anticoagulant medications, four studies investigating the effects of thrombocytopenia and hemodialysis on thrombus formation as measured by the T-TAS, 11 studies testing the applicability of the T-TAS in the monitoring of anticoagulant and antiplatelet therapies and eventually two studies on the ability of the T-TAS to assess the thrombogenicity in different disease entities.

DISCUSSION & CONCLUSION

The T-TAS method is an interesting technology that mimics the complex biological coagulation process using shear forces, creating a "blood vessel component on a chip". More research is needed, but it could eventually function as a screening test for platelet function and coagulation. Moreover, it could be used to detect the presence of anticoagulant and/or antiplatelet medication.

Unfavorably Altered Fibrin Clot Phenotype in Women Following Postpartum Hemorrhage of Unknown Cause: Effect of Lower Coagulation Factors

BACKGROUND

 Increased clot permeability and susceptibility to lysis have been reported in women with heavy menstrual bleeding. We hypothesized that similar alterations in fibrin clot properties may also be present in women with postpartum hemorrhage (PPH) of unknown cause.

OBJECTIVE

 To determine fibrin clot properties and their determinants in women after PPH of unknown cause.

METHODS

 We studied 52 consecutive women, aged 35 years (27-40), after at least 3 months since PPH of unknown cause and 52 matched controls for age, weight, and fibrinogen. Coagulation factors (F), antithrombin, thrombin generation, along with a comprehensive plasma fibrin clot analysis including fibrin polymerization, clot permeability (K s), and fibrinolysis efficiency were determined.

RESULTS

 Women with PPH showed reduced activity of FII (-10.3%), FV (-6.6%), FIX (-6.5%), FX (-7.2%), and FXI (-5.7%) compared with the controls, though all values were within ranges (all p < 0.05). There were no intergroup differences in fibrinogen, FVIII, FXIII, and thrombin generation. The PPH group formed with a delay looser plasma fibrin network (K s; +16.3%, p = 0.008) with lower maximum absorbance and shorter clot lysis time (CLT; -13.5%, p = 0.001) compared with the controls. On multivariable logistic regression, PPH was independently associated with higher C-reactive protein (per 1 mg/L, odds ratio [OR] = 1.70, 95% confidence interval [CI]: 1.09-2.68), lower FII (per 1%, OR = 0.93, 95% CI: 0.89-0.98), lower FV (per 1%, OR = 0.93, 95% CI: 0.89-0.97), and shorter CLT (per 1 minute, OR = 0.94, 95% CI: 0.90-0.98).

CONCLUSION

 Prohemorrhagic fibrin clot properties, with lower, though normal coagulation factors, characterize women with PPH of unknown cause, which suggests novel mechanisms contributing to this type of bleeding.

Unfavorably altered lipid profile in women with primary ovarian insufficiency

BACKGROUND

Hypoestrogenism related to the cessation of ovarian function increases the risk of metabolic disorders in postmenopausal women. Women with primary ovarian insufficiency (POI) are exposed to longer period of estrogen deficiency together with a subsequently higher risk of long-term comorbidities.

OBJECTIVE

To compare metabolic along with hormonal status among newly diagnosed women with POI with pre- and postmenopausal women. To investigate the impact of POI etiology on both metabolic and hormonal profiles.

METHODS

A case-control study with women assigned to one of the groups: 1) POI (n = 216), 2) age-matched premenopausal (n = 216), 3) postmenopausal (n = 227). Lipid profile, fasting glucose and insulin levels together with insulin resistance were determined among all participants.

RESULTS

POI women exhibited increased both total cholesterol (TC, p = 0.04) and low-density lipoprotein cholesterol (LDL-C, p < 0.01) compared to the premenopausal women and higher triglycerides (TG, p < 0.001) than postmenopausal women. POI group showed higher fasting glucose level (p = 0.04) differently to premenopausal women. The idiopathic POI group showed both lower sex hormone binding globulin (p = 0.02) and dehydroepiandrosterone sulfate (p = 0.04) along with reduced TC (p = 0.03) and TG (p = 0.01) together with increased high-density lipoprotein cholesterol (p = 0.04) levels than non-idiopathic POI women.

CONCLUSION

Women with newly diagnosed POI exhibited less favorable lipid profile than pre- or postmenopausal women. The association of negatively changed lipid profile in POI women is mostly mediated by women with unknown cause of premature ovarian cessation.

GnRH Antagonist Protocol Enhances Coagulation During Controlled Ovarian Stimulation for IVF

Changes in coagulation and fibrinolysis have been reported in women undergoing controlled ovarian hyperstimulation (COH) supporting a potential hypercoagulable condition related to this treatment. This study aimed at evaluating the changes in fibrin clot properties and thrombin generation induced by two different COH protocols: long with gonadotropin-releasing hormone agonist (GnRH-a) and GnRH antagonist (GnRH-ant). Primary outcomes included determination of plasma fibrin clot properties, including clot permeability (K_s) and efficiency of fibrinolysis using clot lysis time (CLT), along with thrombin generation (prothrombin fragments 1 + 2) and endogenous thrombin potential (ETP) and fibrinolysis inhibitor levels. One hundred twenty-nine infertile women were included in the final analysis. The GnRH-ant protocol resulted in increased ETP (+ 9.8%) and reduced K_s (- 2.4%). Conversely, COH with the GnRH-a protocol reduced thrombin generation by decreasing both ETP (- 6.6%) and F1 + 2 (- 30.8%) together with favorably altered fibrin clot properties represented by increased K_s (+ 21.7%) and reduced CLT (- 13.8%) as well as decreased PAI-1 levels (by 2.5 times). The GnRH-ant compared to the GnRH-a protocol increased PAI-1 levels (+ 77.3%), thrombin generation (9.3% higher ETP), and K_s (+ 13.7%). In the GnRH-a group, post-COH K_s was 14.3% higher (K_s ≥ 7.92 × 10^-9 cm²) in women with positive vs. negative pregnancy outcomes. Our results show that the GnRH-ant protocol enhanced thrombin generation and slightly decreased fibrin clot density. COH with the GnRH-a reduced thrombin generation and improved fibrin clot features. This trial was registered (NCT04166825). Clinical Trial Registration Number: NCT04166825.