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Xiao H, Yu W, Li L, Yin X, Zhai Q, Hu D, Zhang X, Wang F. Trimester-specific reference intervals of hemostasis biomarkers for healthy pregnancy. Scand J Clin Lab Invest 2023; 83:379-383. [PMID: 37491076 DOI: 10.1080/00365513.2023.2233903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 07/02/2023] [Accepted: 07/02/2023] [Indexed: 07/27/2023]
Abstract
Physiological changes in hemostasis during pregnancy have been reported by several authors. This study aimed at establishing reference intervals for the hemostasis biomarkers thrombin-antithrombin complex (TAT), α2-plasmininhibitor-plasmin complex (PIC), thrombomodulin (TM) and tissue plasminogen activator-inhibitor complex (tPAI-C), in healthy pregnancies. After excluding outliers, a total of 496 healthy pregnant women (128 first-trimester, 142 second-trimester, 107 third-trimester and 119 pre-labor) and 103 healthy nonpregnant women were enrolled from Shenzhen Bao'an Women's and Children's Hospital. Hemostasis biomarkers, TAT, PIC, TM and tPAI-C, were measured by using a quantitative chemiluminescence enzyme immunoassay performed on HISCL automated analysers. The median and reference intervals (the 2.5th and 97.5th percentiles) were calculated to establish trimester-specific reference intervals for healthy pregnant women. The reference intervals for TAT, PIC, TM and tPAI-C in the first trimester were 0.7-7.6 1 µg/L, 0.2-0.9 mg/L, 2.8-11.0 TU/ml, and 1.2-6.5 1 µg/L, respectively. The reference intervals in the second trimester were 1.7-12.0 1 µg/L, 0.2-1.0 mg/L, 3.7-11.6 TU/ml, and 2.8-8.8 1 µg/L, respectively. The reference intervals in the third trimester were 2.7-16.1 1 µg/L, 0.1-1.4 mg/L, 2.9-12.9 TU/ml, and 1.9-8.0 1 µg/L, respectively. At pre-labor, the reference intervals were 4.8-32.9 1 µg/L, 0.2-1.9 mg/L, 4.2-12.6 TU/ml, and 2.8-15.4 1 µg/L, respectively. Gestational reference intervals for TAT, PIC, TM and tPAI-C in healthy pregnancies are provided, but only for TAT with increasing concentrations throughout pregnancy, the reference intervals for non-pregnant were not applicable.
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Affiliation(s)
- Haijun Xiao
- Shenzhen Baoan Women's and Children's Hospital, Guangdong, P.R. China
| | - Weijian Yu
- Shenzhen Baoan Women's and Children's Hospital, Guangdong, P.R. China
| | - Lihua Li
- Shenzhen Baoan Women's and Children's Hospital, Guangdong, P.R. China
| | - Xiaoqin Yin
- Shenzhen Longhua New District People's Hospital, P.R. China
| | - Qingna Zhai
- Shenzhen Baoan Women's and Children's Hospital, Guangdong, P.R. China
| | - Die Hu
- Shenzhen Baoan Women's and Children's Hospital, Guangdong, P.R. China
| | - Xiufa Zhang
- Shenzhen Baoan Women's and Children's Hospital, Guangdong, P.R. China
| | - Feng Wang
- Shenzhen Baoan Women's and Children's Hospital, Guangdong, P.R. China
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Malikova I, Husakova M, Bilkova J, Brzezkova R, Kvasnicka T. Thrombin Decrease in Thrombin Generation after Heparin Administration in a Homozygous Type II Heparin Binding Site Antithrombin-Deficient Pregnant Woman. Med Princ Pract 2023; 32:1. [PMID: 37703851 PMCID: PMC10659590 DOI: 10.1159/000533801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES There is a major problem in providing prophylactic treatment in antithrombin (AT)-deficient pregnant women with a homozygous mutation of the heparin binding site (HBS) and AT level of 17 %. The aim of the study was to determine the effectiveness of heparin by monitoring changes in thrombin generation (TG) in vitro so that pregnant women are not exposed to stress in vivo. METHODS We used the chromogenic method for determination of factor Xa (FXa) inhibition for enoxaparine, nadroparine, dalteparine, fondaparinux and unfractionated heparin (UFH) and the Thrombin Generation Assay (TGA). RESULTS We found that the degree of inhibition is very different when different heparins are compared. Nadroparin reduces TG the most compared to low molecular weight heparins (LMWH). CONCLUSION Routine monitoring of anti FXa activity should be supplemented with TG monitoring, where the effect of LMWH does not manifest itself as this could help in estimating thrombophilic risk during pregnancy.
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Kohli R, Platton S, Forbes S, Thuraisingham R, Tan J, Green L, MacCallum P. Renal transplant and hemostasis: early postoperative changes in recipients and donors. Res Pract Thromb Haemost 2023; 7:100168. [PMID: 37274176 PMCID: PMC10238749 DOI: 10.1016/j.rpth.2023.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/07/2023] [Accepted: 04/10/2023] [Indexed: 06/06/2023] Open
Abstract
Background The benefit of administering pharmacologic thromboprophylaxis following renal transplantation remains uncertain. Objectives To compare hemostatic parameters before and after renal transplant surgery in both recipients and their donors at predetermined time points. Methods Blood samples were collected at baseline (T1), immediately after surgery (T2), and at 24 hours after surgery (T3) in both recipients and donors and at 72 (T4) and 120 hours (T5) from recipients only. Assays included in vitro thrombin generation, factor VIII (FVIIIc) activity, von Willebrand factor (VWF) antigen, D-dimer, antithrombin activity, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes, and plasminogen activator inhibitor-1 (PAI-1) antigen. Results Fifty-two patients (28 recipients and 24 donors) were enrolled. Both donors and recipients had increased FVIIIc, VWF, F1 + 2, D-dimer, and PAI immediately after surgery but reduced antithrombin. Mixed-model analysis showed that the magnitude of change over time (between T1 and T3) for FVIIIc (mean estimated difference [MED], 72; 95% CI, 41-102; P < .0001), VWF (MED, 89; 95% CI, 35-142; P = .001), F1 + 2 (MED, 283; 95% CI, 144-422; P < .0001), thrombin-antithrombin complexes (MED, 3.5; 95% CI, 1.9-5.1; P < .0001), D-dimer (MED, 2.2; 95% CI, 1.0-3.3; P < .0001), PAI-1 (MED, 9.2; 95% CI, 3.4-14.9; P = .002), and time to peak thrombin generation (MED, 1.5; 95% CI, 0.35-2.7; P = .01) was more significant in recipients than in donors. Conclusion Persistence of a hypercoagulable state was more prominent in recipients after 24 hours despite recovery in renal function and initiation of thromboprophylaxis.
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Affiliation(s)
- Ruchika Kohli
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | | | | | | | - Joachim Tan
- St. Georges, University of London, London, United Kingdom
| | - Laura Green
- Barts Health NHS Trust, London, United Kingdom
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- NHS Blood & Transplant, London, United Kingdom
| | - Peter MacCallum
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
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4
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Malikova I, Husakova M, Bilkova J, Brzezkova R, Hrachovinova I, Kvasnicka T. Thrombin Generation Decrease After LMWH Administration in an Antithrombin-Deficient Pregnant Woman With a Homozygous HBS II Mutation. Clin Appl Thromb Hemost 2023; 29:10760296231197174. [PMID: 37670493 PMCID: PMC10483976 DOI: 10.1177/10760296231197174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/04/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
The cases of antithrombin (AT)-deficient pregnant women with a homozygous HBS II mutation are relatively rare and are accompanied by an increased thrombophilic risk, which is manifested by increased thrombin generation (TG). It is very difficult to ensure their prophylactic treatment during pregnancy. We aimed to determine the utility of the thrombin generation assay (TGA) and anti-factor Xa (anti-FXa) test to monitor the effects of a prophylactic dose of low-molecular-weight heparin (LMWH) in a 28-year-old woman with homozygous AT deficiency caused by mutation c.391C > T#, (p.Leu131Phe†) in the SERPINC1 gene and to compare the findings with those from a group of pregnant and non-pregnant women also treated with LMWH. TG monitoring was chosen due to severe AT deficiency that was manifested by low levels of anti-FXa activity when monitoring the efficacy of LMWH treatment. A significant decrease in TG was detected in all monitored groups (P < .05). There were no thrombotic complications during the whole pregnancy of the woman with AT deficiency. Consistent monitoring of TG with LMWH anticoagulant therapy administration during pregnancy together with AT administration before and after delivery may improve the overall condition of pregnant women and the quality of their care.
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Affiliation(s)
- Ivana Malikova
- Central Hematological Laboratory, General University Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Martina Husakova
- Central Hematological Laboratory, General University Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Jana Bilkova
- Thrombotic Centre of Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Radka Brzezkova
- Thrombotic Centre of Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic
| | | | - Tomas Kvasnicka
- Thrombotic Centre of Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic
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O’Keefe D, Lim HY, Hui L, Ho P. Risk stratification for pregnancy-associated venous thromboembolism: Potential role for global coagulation assays. Obstet Med 2022; 15:168-175. [PMID: 36262814 PMCID: PMC9574445 DOI: 10.1177/1753495x211025397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 09/03/2023] Open
Abstract
Risk assessment for venous thromboembolism in pregnancy and the puerperium is currently limited to stratifying clinical surrogate risk factors without high-quality evidence. While the absolute risk of pregnancy-associated venous thromboembolism is low for the vast majority of women, associated morbidity and mortality remains significant. As guidelines for thromboprophylaxis vary widely, some women may be under- or over-anticoagulated, contributing to poor outcomes. New global coagulation assays provide a holistic view of coagulation and may have the potential to detect hypercoagulability in pregnancy, unlike clinically available coagulation assays. However, there are major technical challenges to overcome before global coagulation assays can be realistically proposed as an adjunct to risk assessment for pregnancy-associated venous thromboembolism. This review summarises the literature and controversies in the prediction and prevention of pregnancy-associated venous thromboembolism and outlines the new tools in haematology that may assist in our future understanding of hypercoagulability in pregnancy.
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Affiliation(s)
- David O’Keefe
- Department of Obstetrics & Gynaecology, The University of
Melbourne, The University of Melbourne, Parkville, Australia
- Department of Obstetrics & Gynaecology, Northern Health,
Epping, Australia
| | - Hui Yin Lim
- Department of Haematology, Northern Pathology Victoria, Epping,
Australia
- Department of Haematology, Northern Health, Epping,
Australia
| | - Lisa Hui
- Department of Obstetrics & Gynaecology, The University of
Melbourne, The University of Melbourne, Parkville, Australia
- Department of Obstetrics & Gynaecology, Northern Health,
Epping, Australia
| | - Prahlad Ho
- Department of Haematology, Northern Pathology Victoria, Epping,
Australia
- Department of Haematology, Northern Health, Epping,
Australia
- Australian Centre for Blood Diseases, Monash University,
Melbourne, Australia
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6
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Kasonga F, Feugray G, Chamouni P, Barbay V, Fresel M, Chretien MH, Brunel S, Le Cam Duchez V, Billoir P. Evaluation of thrombin generation assay in factor XI deficiency. Clin Chim Acta 2021; 523:348-354. [PMID: 34670127 DOI: 10.1016/j.cca.2021.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Factor XI (FXI) deficiency is characterized by a lack of correlation between FXI plasma levels and the occurrence of hemorrhagic events. The main objective of our study was to determine whether thrombin generation assay (TGA) could be used to assess the hemorrhagic phenotype of patients with FXI deficiency. MATERIAL AND METHODS All patients had confirmed laboratory measurement of FXI < 50% in two plasma samples. Relevant bleeding history was evaluated by a senior physician. TGA was performed with Calibrated Automated Thrombography, in platelet poor plasma, from patients and healthy controls. The assay was performed with PPP low reagent (1 pM of human tissue factor). RESULTS Seventy-six patients with FXI deficiency were included between 2011 and 2020. Among them, eight patients had severe deficiency (FXI < 15%). Mean age was 34 years [range: 9-77]. Endogenous thrombin potential (ETP) was significantly lower in patients with FXI deficiency and bleeding (573 nM·min [225-1214]) or no bleeding (732 nM·min [222-1435]), compared to healthy controls (1184 nM·min [933-1518]). No difference was observed for ETP and peak between patients with FXI deficiency and bleeding and patients with FXI deficiency and no bleeding. No difference was observed for ETP (923 nM·min [377-1497] vs 1063 nM·min [252-2529]), peak (82 nM [28-154] vs 131 nM [20-330]) or velocity (13.7 nM/min [3.6-29.6] vs 26.5 nM/min [2.5-90]) in women with (n = 4) and without history (n = 17) of post-partum bleeding. No difference of thrombin generation was observed in pregnant women with FXI deficiency (ETP: 1395 nM·min [351-2529]; peak: 154 nM [26-330]; velocity: 29.6 nM/min [4.1-90.0]), compared to healthy controls and a control group of healthy pregnant women. CONCLUSION In conclusion, under our experimental condition, a non-significant decrease of thrombin generation was observed in plasma samples of patients with FXI deficiency and bleeding. Our results suggest an increase of coagulation parameters during pregnancy in women with FXI deficiency. A larger sample size or other experimental conditions are required to evaluate the use of TGA in FXI deficiency.
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Affiliation(s)
- Fiston Kasonga
- CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | - Guillaume Feugray
- Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | | | - Virginie Barbay
- CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France; CHU Rouen, Hemophilia Care Center, F 76000 Rouen, France
| | | | | | - Sabine Brunel
- CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | - Véronique Le Cam Duchez
- Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | - Paul Billoir
- Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France.
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7
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Mandlebe B, Orundami OI, Lynch LA, Teale G, Said JM, Cutts BA. Maternal thrombin generation and D-dimer levels in obesity and pregnancy: results from the maternal thrombin generation in obesity and pregnancy (MaTOPs) study. Blood Coagul Fibrinolysis 2021; 32:394-400. [PMID: 34117131 DOI: 10.1097/mbc.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Venous thromboembolic disease (VTE) risk increases five-fold antenatally and 14-fold during the puerperium. Obesity significantly increases this risk. The D-dimer assay and more novel Calibrated Automated Thrombogram (CAT) assay laboratory tests display potential for use in VTE risk stratification in pregnancy, although to date, research in the performance characteristics of these tests in obese and nonobese pregnant populations is limited. The aim of this study was to compare D-dimer and thrombin generation levels in obese and nonobese pregnant women. Pregnant women were recruited and categorised, as obese (BMI ≥30) or nonobese (BMI 18.5-25). Blood was collected at 26-28 weeks' gestation, 36-40 weeks' gestation and 6-12 weeks postpartum and D-dimer concentrations and endogenous thrombin potential (ETP) were determined. Student's t-test was used to analyse differences in mean D-dimer and ETP. At 36-40 weeks, obese pregnant women had higher D-dimer concentrations (P = 0.001) but lower ETP levels compared with nonobese women (P = 0.044). D-dimer was higher in nonobese than in obese women at 6-12 weeks postpartum (P = 0.026). There was no difference in mean D-dimer (P = 0.825) and mean ETP (P = 0.424) between obese and nonobese women at 26-28 weeks. No difference was observed in mean ETP at 6-12 weeks postpartum (P = 0.472). ETP was lower in both obese and nonobese women postpartum than during pregnancy. D-dimer was lower in obese women but not in nonobese women postpartum. D-dimer concentrations and ETP were not significantly different during multiple time points in pregnancy and postpartum between obese and nonobese pregnant women suggesting limited utility in VTE risk assessment in obese pregnant women.
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Affiliation(s)
- Batsho Mandlebe
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne
| | | | - Lee-Anne Lynch
- Women's and Children's Division, Joan Kirner Women's and Children's at Sunshine Hospital, St Albans
| | - Glyn Teale
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne
- Women's and Children's Division, Joan Kirner Women's and Children's at Sunshine Hospital, St Albans
| | - Joanne M Said
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne
- Women's and Children's Division, Joan Kirner Women's and Children's at Sunshine Hospital, St Albans
- Department of Obstetrics, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Briony A Cutts
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne
- Women's and Children's Division, Joan Kirner Women's and Children's at Sunshine Hospital, St Albans
- Department of Obstetrics, The Royal Women's Hospital, Parkville, Victoria, Australia
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Feugray G, Billoir P, Casini A, Neerman-Arbez M, Barbay V, Chamouni P, Schneider P, Le Cam Duchez V. Afibrinogenemia with two compound heterozygous mutations in FGA gene. Haemophilia 2021; 27:e641-e644. [PMID: 34255402 DOI: 10.1111/hae.14377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Guillaume Feugray
- UNIROUEN, INSERM U1096, Vascular Hemostasis Unit, Normandie University, Rouen University Hospital, France
| | - Paul Billoir
- UNIROUEN, INSERM U1096, Vascular Hemostasis Unit, Normandie University, Rouen University Hospital, France
| | - Alessandro Casini
- Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - M Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Virginie Barbay
- UNIROUEN, INSERM U1096, Vascular Hemostasis Unit, Normandie University, Rouen University Hospital, France.,Hemophilia Care Center, Rouen University Hospital, Rouen, France
| | - Pierre Chamouni
- Hemophilia Care Center, Rouen University Hospital, Rouen, France
| | - Pascale Schneider
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen, France
| | - Véronique Le Cam Duchez
- UNIROUEN, INSERM U1096, Vascular Hemostasis Unit, Normandie University, Rouen University Hospital, France.,Hemophilia Care Center, Rouen University Hospital, Rouen, France
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Miller MJ, Maier CL, Duncan A, Guarner J. Assessment of Coagulation and Hemostasis Biomarkers in a Subset of Patients With Chronic Cardiovascular Disease. Clin Appl Thromb Hemost 2021; 27:10760296211032292. [PMID: 34235983 PMCID: PMC8274080 DOI: 10.1177/10760296211032292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Measurement of a single marker of coagulation may not provide a complete picture of hemostasis activation and fibrinolysis in patients with chronic cardiovascular diseases. We assessed retrospective orders of a panel which included prothrombin fragment 1.2 (PF1.2), thrombin: antithrombin complexes, fibrin monomers, and D-dimers in patients with heart assist devices, cardiomyopathies, atrial fibrillation and intracardiac thrombosis (based on ordering ICD-10 codes). During 1 year there were 117 panels from 81 patients. Fifty-six (69%) patients had heart assist devices, cardiomyopathy was present in 17 patients (21%) and 29 patients (36%) had more than 1 condition. PF1.2 was most frequently elevated in patients with cardiomyopathy (61.1%) compared to those with cardiac assist devices (15.7%; P = 0.0002). D-dimer elevation was more frequent in patients with cardiac assist devices (98.8%) compared to those patients with cardiomyopathy (83.3%; P = 0.014). Patients with cardiomyopathy show increases of PF1.2 suggesting thrombin generation. In contrast, elevations of D-dimers without increase in other coagulation markers in patients with cardiac assist devices likely reflect the presence of the intravascular device and not necessarily evidence of hemostatic activation.
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Affiliation(s)
- Maureen J Miller
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexander Duncan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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10
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Wu Y, Qiao Y, Zhang Y, Li Q, Zhang W. Trimester-specific reference intervals of TAT, TM, tPAI-C and PIC for healthy Chinese pregnant women. J Obstet Gynaecol Res 2020; 47:368-374. [PMID: 33345424 DOI: 10.1111/jog.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
AIM Pregnancy is a hypercoagulability state, the aim of this study was to observe the changes of thrombin-antithrombin complex (TAT), thrombomodulin (TM), tissue plasminogen activator-inhibitor complex (tPAI-C) and plasmin-α2-antiplasmin complex (PIC) during pregnancy and establish trimester-specific reference intervals for Chinese healthy pregnant women. METHODS In total 190 Chinese healthy pregnant women (first trimester 59 cases, second trimester 60 cases and third trimester 71 cases) were recruited in North China. TAT, TM, tPAI-C and PIC were processed on Sysmex HISCL 5000 automated chemiluminescence immune detection system. Trimester-specific reference intervals were established with the 2.5th and 97.5th percentile of the distribution. RESULTS The reference intervals for TAT, TM, tPAI-C, PIC at trimester 1 were 0.40-3.65 ng/mL, 4.85-8.80 TU/mL, 1.75-6.40 ng/mL, 0.25-1.05 μg/mL, respectively. At trimester 2, the reference intervals were 1.65-8.61 ng/mL, 5.70-9.93 TU/mL, 2.91-7.71 ng/mL, 0.33-2.02 μg/mL, respectively. At trimester 3, the reference intervals were 3.16-12.68 ng/mL, 5.50-14.24 TU/mL, 2.70-10.69 ng/mL, 0.24-1.54 μg/mL, respectively. CONCLUSIONS The changes of TAT, TM, tPAI-C, PIC during pregnancy are presented, and trimester-specific reference intervals for healthy pregnant women are described. The levels of TAT, TM, tPAI-C were increased gradually from trimester 1 to trimester 3, while the PIC level remains stable during all trimesters.
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Affiliation(s)
- Yufeng Wu
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yan Qiao
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yinmei Zhang
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Qingsong Li
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Wenjing Zhang
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
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11
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Kristoffersen AH, Petersen PH, Bjørge L, Røraas T, Sandberg S. Concentration of fibrin monomer in pregnancy and during the postpartum period. Ann Clin Biochem 2019; 56:692-700. [PMID: 31370675 DOI: 10.1177/0004563219869732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background D-dimer increases during pregnancy and is problematic to use in the diagnosis of venous thromboembolism. Fibrin monomer represents an alternative biomarker for venous thromboembolism. However, to be useful in pregnancy, the fibrin monomer concentration should be stable throughout pregnancy and during postpartum. Methods To describe the course of fibrin monomer concentration during pregnancy and the postpartum period in healthy pregnant women and to compare their within-subject biological variation (CVI) with non-pregnant women. Blood samples were obtained every fourth week during pregnancy and three samples after delivery in 20 healthy women and every fourth week during a 40-week period in 19 healthy non-pregnant women. Fibrin monomer (STA Liatest FM, Stago) was analysed in duplicates for all samples. Concentrations of fibrin monomer in pregnant and non-pregnant women were compared and the CVI for fibrin monomer was calculated. Results The median fibrin monomer concentration in pregnant women was 6.2 mg/L (2.5 and 97.5 percentiles 3.7–10.8 mg/L) and in non-pregnant women 4.8 mg/L (3.6–8.2) ( P < 0.01). The fibrin monomer concentration was relatively stable during pregnancy, although a few unexplained high fibrin monomer concentrations were found during pregnancy/postpartum. Fibrin monomer CVI in pregnancy and postpartum was 20.6% (95% CI 18.3, 23.5) and in non-pregnant 16.1% (13.7, 18.9). Conclusions For clinical purposes, fibrin monomer concentration can be considered stable during pregnancy, although it is slightly higher than in non-pregnant women. Pregnant and non-pregnant women have the same CVI. The suitability of fibrin monomer in venous thromboembolism diagnosis in pregnant women should be validated in further studies.
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Affiliation(s)
- Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Per Hyltoft Petersen
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Line Bjørge
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Thomas Røraas
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Department of Medical Biochemistry and Pharmacology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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12
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Dong F, Wang L, Wang C. Thrombin Generation in Chinese Pregnant Women and the Effect of Insulin Use on Thrombin Generation in Patients with GDM. Clin Appl Thromb Hemost 2019; 25:1076029619863492. [PMID: 31311294 PMCID: PMC6714913 DOI: 10.1177/1076029619863492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pregnancy is a hypercoagulable state associated with an increased risk of venous thrombosis. Calibrated automated thrombogram (CAT) is a test to monitor the thrombin generation (TG), a laboratory marker of thrombosis risk, and increases during normal pregnancy, but it is still unclear whether TG is related to the use of insulin in pregnant women with gestational diabetes mellitus (GDM). We performed thrombin generation by CAT on 135 normal pregnant women, including 43 in first trimester, 32 in second trimester, 60 in third trimester, respectively; 68 pregnant women with GDM were also enrolled, 19 patients with GDM using insulin to control blood glucose and 49 patients control their blood glucose through diet and exercise with noninsulin treatment. The overall CAT parameters were calculated using descriptive statistics method with mean ± standard deviation. Mean endogenous thrombin potential, peak thrombin generation, and StartTail time increased significantly with the pregnancy. There was no significant difference in TG test parameters except StartTail time(P = .003) in insulin-treated GDM group when compared to those without insulin in the GDM group. The normal ranges for CAT parameters in pregnant women were determined. Thrombin generation increased significantly in first trimester and remains stable in second and third trimester. The use of insulin in patient with GDM did not affect thrombin generation test. Our study helps to establish the reference range of thrombin generation in Chinese normal pregnant population and provide more basis to predict the risk of thrombus complicating during pregnancy.
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Affiliation(s)
- Feng Dong
- 1 Department of Medical Laboratory Center, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.,2 Department of Laboratory Medicine, The Civil Aviation General Hospital, Beijing, People's Republic of China
| | - Longhao Wang
- 3 Department of Otolaryngology and Head and Neck Surgery, Shanghai Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chengbin Wang
- 1 Department of Medical Laboratory Center, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
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13
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Bagot CN, Leishman E, Onyiaodike CC, Jordan F, Gibson VB, Freeman DJ. Changes in laboratory markers of thrombotic risk early in the first trimester of pregnancy may be linked to an increase in estradiol and progesterone. Thromb Res 2019; 178:47-53. [PMID: 30965151 DOI: 10.1016/j.thromres.2019.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pregnant women are at increased risk of venous thrombosis compared to non-pregnant women. Epidemiological and laboratory data suggest that hypercoagulability begins in the first trimester but it is unknown exactly how early in pregnancy this develops. The mechanisms that result in a prothrombotic state may involve oestrogens and progestogens. METHODS Plasma samples were taken prior to conception and five times in early pregnancy, up to Day 59 gestation, from 22 women undergoing natural cycle in vitro fertilization, who subsequently gave birth at term following a normal pregnancy. Thrombin generation, free Protein S, Ddimer, Fibrinogen, factor VIII, estradiol and progesterone were measured. To counter inter-individual variability, the change in laboratory measurements between the pre-pregnant and pregnant state were measured over time. RESULTS Peak thrombin, Endogenous Thrombin Potential, Velocity Index and fibrinogen significantly increased, and free Protein S significantly decreased, from pre-pregnancy levels, by 32 days gestation. Ddimer and VIII significantly increased from pre-pregnancy levels by 59 days gestation. Estradiol significantly increased by Day 32 gestation with a non-significant increase of 67% by Day 24 gestation. Progesterone significantly increased by Day 32 gestation. Almost all laboratory markers of thrombosis correlated significantly with estradiol and progesterone. CONCLUSION Our work is the first to demonstrate that the prothrombotic state develops very early in the first trimester. Laboratory markers of hypercoagulability correlate significantly with estradiol and progesterone suggesting these are linked to the prothrombotic state of pregnancy. Clinicians should consider commencing thromboprophylaxis early in the first trimester in women at high thrombotic risk.
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Affiliation(s)
- C N Bagot
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK.
| | - E Leishman
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | - C C Onyiaodike
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - F Jordan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - V B Gibson
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | - D J Freeman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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14
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Tang J, Lin Y, Mai H, Luo Y, Huang R, Chen Q, Xiao D. Meta-analysis of reference values of haemostatic markers during pregnancy and childbirth. Taiwan J Obstet Gynecol 2019; 58:29-35. [PMID: 30638475 DOI: 10.1016/j.tjog.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 01/11/2023] Open
Abstract
Previously reported haemostatic reference intervals in normal pregnancy displayed considerable contradictions to establish convince gestational age-related haemostatic reference values. 30 clinical reports were recruited to collect and assemble existing clinical reports from the database D-dimer levels increased progressively with gestational ages and exceeded conventional value of 1 mg/L after 29-36 weeks, and reached a peak at 24 h postpartum with mean value of 6.44 mg/L [95% confidence interval (CI): 5.84 to 7.05] and returned to 0.79 mg/L (95% CI: 0.43 to 1.16) at 1-8 weeks postpartum. Analogously, the level of fibrinogen gradually increased throughout the pregnancy, and peaked at 48-72 h after birth, with mean value of 9.05 g/L (95% CI: 2.22 to 15.89) and then returned to 3.62 g/L (95% CI: 3.03 to 4.20) at 1-8 weeks postpartum. However, in the middle trimester, asynchronously prothromb in fragments 1 + 2 (F1+2) level elevated and reached a peak at 28-36 weeks with mean value of 3.05 nmol/L (95% CI: 2.41 to 3.70), and then decreased in the later trimester, and reached 1.92 nmol/L (95% CI: 0.58 to 3.27) at 48-72 h post-partum, close to normal levels. Previously reported gestational age-related haemostatic reference intervals in pregnancy could not be used as a standard.
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Affiliation(s)
- Juxian Tang
- Department of Hematology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong 510630, China
| | - Yihui Lin
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong 510630, China
| | - Huachao Mai
- Internal Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong 511400, China
| | - Yiping Luo
- Internal Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong 511400, China
| | - Renwei Huang
- Department of Hematology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong 510630, China
| | - Qi Chen
- Department of Hematology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong 510630, China
| | - Duan Xiao
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China.
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15
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Lucena FC, Lage EM, Teixeira PG, Barbosa AS, Diniz R, Lwaleed B, Talvani A, Alpoim PN, Perucci LO, Dusse LMS. Longitudinal assessment of D-dimer and plasminogen activator inhibitor type-1 plasma levels in pregnant women with risk factors for preeclampsia. Hypertens Pregnancy 2019; 38:58-63. [PMID: 30760065 DOI: 10.1080/10641955.2019.1577435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Investigating D-Dimer/D-Di and plasminogen activator inhibitor type-1/PAI-1 levels throughout gestation in women with preeclampsia/PE risk factors. METHODS D-Di and PAI-1 plasma levels were determined in 28 women at 12-19, 20-29, 30-34 and 35-40 weeks of gestation. RESULTS D-Di was lower at 12-19 weeks and higher at 30-34 weeks in women who developed PE versus who did not develop it. D-Di increased throughout gestation in both groups, peaking earlier in pregnant women who developed PE versus who did not develop it. PA1-1 increased across gestation, but it didn't differ between groups. CONCLUSION D-Di was able to discriminate these groups of women at 12-19 and 30-34 weeks of gestation.
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Affiliation(s)
- Flávia Campos Lucena
- a Department of Clinical and Toxicological Analysis, Faculty of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Eura Martins Lage
- b Department of Gynecology and Obstetrics, Faculty of Medicine , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Patrícia Gonçalves Teixeira
- b Department of Gynecology and Obstetrics, Faculty of Medicine , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Alexandre Simões Barbosa
- b Department of Gynecology and Obstetrics, Faculty of Medicine , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Rejane Diniz
- c Department of Epidemiology , Veterinary School, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Bashir Lwaleed
- d Department of Urology , University of Soutampton , Southampton , UK
| | - André Talvani
- e Department of Biological Sciences, Institute of Exact and Biological Sciences , Federal University of Ouro Preto , Ouro Preto , Brazil
| | - Patrícia Nessralla Alpoim
- a Department of Clinical and Toxicological Analysis, Faculty of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Luiza Oliveira Perucci
- f Nucleus of Research in Biological Sciences , Federal University of Ouro Preto , Ouro Preto , Brazil
| | - Luci Maria SantAna Dusse
- a Department of Clinical and Toxicological Analysis, Faculty of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
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16
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Dallaku K, Shakur-Still H, Beaumont D, Roberts I, Huque S, Delius M, Holdenrieder S, Gliozheni O, Mansmann U. No effect of tranexamic acid on platelet function and thrombin generation (ETAPlaT) in postpartum haemorrhage: a randomised placebo-controlled trial. Wellcome Open Res 2019; 4:21. [PMID: 31223662 PMCID: PMC6556984 DOI: 10.12688/wellcomeopenres.14977.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. To determine whether TXA has pro-thrombotic effects in women with PPH, we measured endogenous thrombin potential (ETP), coagulation factors V, VIII, von Willebrand (vW), fibrinogen, D-Dimers and platelet function. Methods: We conducted a sub-study within the WOMAN trial, an international randomized, parallel-group, double blind, placebo-controlled trial. Women with primary PPH were randomly allocated to receive 1 gram of tranexamic acid or matching placebo. Baseline blood samples were collected just prior to the first dose and a follow up sample was collected 30±15 minutes afterwards. We compared before and after changes in coagulation parameters between treatment groups using repeated measurement ANOVA. Change in ETP was the primary outcome. We did an intention-to-treat analysis using ANCOVA with adjustment for baseline and the time interval between the blood samples. Findings: A total of 187 patients were randomized to receive TXA (n=93) or matching placebo (n=94). Six patients were excluded due to incomplete data. The reduction in ETP from baseline to follow up was 43.2 nM*min (95%CI, -16.6 to 103.1) in the TXA group and 4.6 nM*min (95%CI, -51.4 to 60.6) in the placebo group. The difference was not statistically significant (95%CI, -42.9 to 120). There were no significant effects of TXA treatment on any other parameters (ADPtest, TRAPtest, coagulation factors activity, fibrinogen levels, D-Dimer level). Conclusion: We found no evidence that tranexamic acid treatment for PPH has substantial pro-coagulant effects. However, larger studies are needed to confirm or refute more modest effects. Trial registration: ISRCTN76912190 (initially registered 10/12/2008, WOMAN-ETAPlat included on 28/10/2013) and NCT00872469 (initially registered 31/03/2009, WOMAN-ETAPlat included on 28/10/2013).
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Affiliation(s)
- Kastriot Dallaku
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital LMU, Munich, Germany.,University Hospital of Obstetrics Gynaecology "Koço Gliozheni", Tirana, Albania
| | | | - Danielle Beaumont
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Sumaya Huque
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Delius
- Department of Obstetrics and Gynaecology, University Hospital LMU, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Munich, Germany
| | - Orion Gliozheni
- University Hospital of Obstetrics Gynaecology "Koço Gliozheni", Tirana, Albania
| | - Ulrich Mansmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital LMU, Munich, Germany
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17
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Friedrich MJ, Schmolders J, Rommelspacher Y, Strauss A, Rühl H, Mayer G, Oldenburg J, Wirtz DC, Müller J, Pötzsch B. Activity Pattern Analysis Indicates Increased but Balanced Systemic Coagulation Activity in Response to Surgical Trauma. TH OPEN 2018; 2:e350-e356. [PMID: 31249960 PMCID: PMC6524900 DOI: 10.1055/s-0038-1673390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/23/2018] [Indexed: 02/07/2023] Open
Abstract
In the nonbleeding patient, constant low-level activation of coagulation enables a quick procoagulant response upon an injury. Conversely, local activation of coagulation might influence the systemic activity level of coagulation. To characterize this interaction in more detail, activity pattern analysis was performed in patients undergoing elective surgeries. Blood samples were taken before, during, and 24 hours after surgery from 35 patients undergoing elective minor (
n
= 18) and major (
n
= 17) orthopaedic surgeries. Plasma levels of thrombin and activated protein C (APC) were measured using oligonucleotide-based enzyme capture assays, while those of prothrombin fragment 1.2, thrombin–antithrombin-complexes, and D-dimer were measured using commercially available enzyme-linked immunosorbent assays. In vitro thrombin generation kinetics were recorded using calibrated automated thrombography. Results showed that median plasma levels of up to 20 pM thrombin and of up to 12 pM APC were reached during surgery. D-dimer levels started to increase at the end of surgery and remained increased 24 hours after surgery, while all other parameters returned to baseline. Peak levels showed no significant differences between minor and major surgeries and were not influenced by the activity state at baseline. In vitro thrombin generation kinetics remained unchanged during surgery. In summary, simultaneous monitoring of the procoagulant and anticoagulant pathways of coagulation demonstrates that surgical trauma is associated with increased systemic activities of both pathways. Activity pattern analysis might be helpful to identify patients at an increased risk for thrombosis due to an imbalance between surgery-related thrombin formation and the subsequent anticoagulant response.
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Affiliation(s)
- Max Julian Friedrich
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Jan Schmolders
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Yorck Rommelspacher
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Andreas Strauss
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Heiko Rühl
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Günter Mayer
- Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Jens Müller
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
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18
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Joly BS, Coppo P, Veyradier A. Pediatric thrombotic thrombocytopenic purpura. Eur J Haematol 2018; 101:425-434. [PMID: 29889319 DOI: 10.1111/ejh.13107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Abstract
Child-onset thrombotic thrombocytopenic purpura (TTP) is a rare entity of thrombotic microangiopathy (TMA). The pathophysiology of the disease is based on a severe functional deficiency of ADAMTS13 (activity <10%), the specific von Willebrand factor (VWF)-cleavage protease. This deficiency may be either acquired (associated anti-ADAMTS13 autoantibodies) or congenital (resulting from biallelic mutations of ADAMTS13 gene). ADAMTS13 deficiency is responsible for the accumulation of high molecular weight multimers of VWF and the formation of platelet thrombi in the microcirculation. Consequently, microangiopathic hemolytic anemia and consumption thrombocytopenia are associated with organ ischemia. The differential diagnosis with other TMAs, autoimmune cytopenias or hematological malignancies may be challenging. The exploration of ADAMTS13 (activity, antibodies, antigen, ADAMTS13 gene) supports the diagnosis of TTP. The first-line treatment of the acute phase of TTP is based on plasmatherapy. In congenital TTP, patients with a chronic disease benefit from a prophylactic plasmatherapy. In autoimmune TTP, steroids and B-cells depleting therapies increasingly are used together with plasma exchange. Long-term follow-up including the monitoring of ADAMTS13 activity is mandatory. A severe decrease in ADAMTS13 activity (<10%) may predict relapses and preemptive B-cell depletion with rituximab can be used to prevent relapses.
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Affiliation(s)
- Bérangère S Joly
- Service d'hématologie biologique, groupe hospitalier Saint-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Paris, France.,EA3518 Recherche clinique en hématologie, immunologie et transplantation, équipe microangiopathies thrombotiques, ADAMTS13 et facteur Willebrand, Centre Hayem, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France.,Centre National de Référence Maladies Rares des MicroAngiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Paul Coppo
- Centre National de Référence Maladies Rares des MicroAngiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Paris, France.,Service d'hématologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Agnès Veyradier
- Service d'hématologie biologique, groupe hospitalier Saint-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Paris, France.,EA3518 Recherche clinique en hématologie, immunologie et transplantation, équipe microangiopathies thrombotiques, ADAMTS13 et facteur Willebrand, Centre Hayem, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France.,Centre National de Référence Maladies Rares des MicroAngiopathies Thrombotiques (CNR-MAT), Assistance Publique-Hôpitaux de Paris, Paris, France
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19
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Joly BS, Sudrié-Arnaud B, Barbay V, Borg JY, Le Cam Duchez V. Thrombin generation test as a marker for high risk venous thrombosis pregnancies. J Thromb Thrombolysis 2018; 45:114-121. [PMID: 29032523 DOI: 10.1007/s11239-017-1572-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pregnancy is a well-established risk factor for venous thromboembolism and is associated with a state of hypercoagulability. The use of sensitive and specific biological markers to predict risk factors for thrombosis is essential during pregnancy. Our objective was to investigate the usefulness of thrombin generation test (TGT) as a marker to predict the risk of thrombosis in high risk venous thrombosis (HRVT) pregnancies compared to normal pregnancies. This retrospective study enrolled 134 women with HRVT pregnancies, 78 of whom had monozygotic, spontaneous and untreated pregnancies and formed the study group. The control group comprised 106 women with normal pregnancies. Routine assessment of coagulation activation markers: fibrinogen, D-dimer, prothrombin fragments 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT) and fibrin monomer complexes (FMC) was performed every 5 weeks in the study group to detect a possible pathological state of hypercoagulability. TGT was performed using platelet-free plasma, 1 and 5 pM tissue factor (TF), supplemented by phospholipids (PL) ± thrombomodulin. Fibrinogen, D-dimer, F1 + 2, and TAT, but not FMC, increased significantly throughout pregnancy in both groups but no difference was shown between the groups. TGT showed an early increase in thrombin generation in both groups, which stabilized during the second month of pregnancy. No correlation was demonstrated between thrombin generation parameters and coagulation activation markers. Based on our results, TGT did not prove conclusive as a marker to predict the risk of thrombosis in HRVT pregnancies. Finding a sensitive and specific biological marker to predict thrombosis risk requires further investigation.
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Affiliation(s)
- Bérangère S Joly
- Department of Biological Hematology, Rouen University Hospital, F 76000, Rouen, France.,Hôpital Lariboisière, Service d'Hématologie Biologique, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | | | - Virginie Barbay
- Normandie Univ, UNIROUEN, Inserm 1096, Department of Biological Hematology, Rouen University Hospital, F 76000, Rouen, France
| | - Jeanne-Yvonne Borg
- Department of Biological Hematology, Rouen University Hospital, F 76000, Rouen, France
| | - Véronique Le Cam Duchez
- Normandie Univ, UNIROUEN, Inserm 1096, Department of Biological Hematology, Rouen University Hospital, F 76000, Rouen, France.
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20
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Bagot C, Leishman E, Onyiaodike C, Jordan F, Freeman D. Normal pregnancy is associated with an increase in thrombin generation from the very early stages of the first trimester. Thromb Res 2017; 157:49-54. [DOI: 10.1016/j.thromres.2017.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/23/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
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21
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Sekiya A, Hayashi T, Kadohira Y, Shibayama M, Tsuda T, Jin X, Nomoto H, Asakura H, Wada T, Ohtake S, Morishita E. Thrombosis Prediction Based on Reference Ranges of Coagulation-Related Markers in Different Stages of Pregnancy. Clin Appl Thromb Hemost 2016; 23:844-850. [DOI: 10.1177/1076029616673732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Careful monitoring of the hypercoagulable state is required during pregnancy. However, coagulation and fibrinolysis markers are not fully utilized because there are no reference values reflective of coagulation and fibrinolysis dynamics during pregnancy, which differ from the nonpregnant state. Methods: Changes in antithrombin (AT), fibrinogen (Fbg), prothrombin fragment 1+2 (F1+2), thrombin–antithrombin complex (TAT), soluble fibrin (SF), D-dimer (DD), and protein S (PS) were investigated in healthy pregnant women, and reference ranges in the early, mid, late, and end stages of pregnancy were established. Results: The AT was essentially constant throughout pregnancy. The Fbg, F1+2, TAT, and DD increased significantly as pregnancy progressed. In contrast, SF did not show a significant increase throughout the entire pregnancy period. Total PS antigen and total PS activity showed a corresponding decrease from early gestation. When test data in 3 cases in which deep vein thrombosis or intrauterine fetal death occurred during pregnancy were compared to the established reference ranges, all of the cases had multiple markers with values that exceeded the reference ranges. Conclusion: Establishing reference ranges for each week could potentially make it possible to evaluate abnormalities of the coagulation and fibrinolysis systems during pregnancy. Of note, SF might be a useful marker that reflects thrombus formation during pregnancy. Larger-scale studies will be required to establish reference ranges for every gestational week.
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Affiliation(s)
- Akiko Sekiya
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Tomoe Hayashi
- Department of Hematology, Kanazawa City Hospital, Heiwa-machi, Kanazawa, Ishikawa, Japan
| | - Yasuko Kadohira
- Department of Internal Medicine (III), Kanazawa University, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Masami Shibayama
- Department of Clinical Laboratory, Kanazawa University Hospital, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Tomohide Tsuda
- Shino-Test Corporation, Oonodai, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Xiuri Jin
- Shino-Test Corporation, Oonodai, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Haruka Nomoto
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Hidesaku Asakura
- Department of Internal Medicine (III), Kanazawa University, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Takashi Wada
- Department of Clinical Laboratory, Kanazawa University Hospital, Takara-machi, Kanazawa, Ishikawa, Japan
- Division of Nephrology, Department of Laboratory Medicine, Kanazawa University, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Shigeki Ohtake
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
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22
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Grossman KB, Arya R, Peixoto AB, Akolekar R, Staboulidou I, Nicolaides KH. Maternal and pregnancy characteristics affect plasma fibrin monomer complexes and D-dimer reference ranges for venous thromboembolism in pregnancy. Am J Obstet Gynecol 2016; 215:466.e1-8. [PMID: 27179442 DOI: 10.1016/j.ajog.2016.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND D-dimers have a high negative predictive value for excluding venous thromboembolism outside of pregnancy but the use in pregnancy remains controversial. A higher cut-off value has been proposed in pregnancy due to a continuous increase across gestation. Fibrin monomer complexes have been considered as an alternative diagnostic tool for exclusion of venous thromboembolism in pregnancy due to their different behavior. OBJECTIVE We sought to establish normal values of fibrin monomer complexes and D-dimer as a diagnostic tool for the exclusion of venous thromboembolism in pregnancy and examine the effect of maternal and obstetric factors on these markers. STUDY DESIGN Plasma D-dimer and fibrin monomer complexes were measured by quantitative immunoturbidimetry in 2870 women with singleton pregnancies attending their routine first-trimester hospital visit in a prospective screening study for adverse obstetric outcome. Multiple regression analysis was used to determine maternal characteristics and obstetric factors affecting the plasma concentrations and converting these into multiple of the median values after adjusting for significant maternal and obstetric characteristics. RESULTS Plasma fibrin monomer complexes increased with maternal weight and were lower in women with a history of cocaine abuse and chronic hypertension. D-dimers increased with gestational age and maternal weight and were higher in sickle cell carriers and in women of African and South Asian racial origin compared to Caucasians. CONCLUSION Fibrin monomer complexes and D-dimers are affected by maternal and obstetric characteristics rather than only gestational age. The utility of these fibrin-linked markers as a tool for exclusion of venous thromboembolism in pregnancy might be improved by adjusting for patient-specific characteristics.
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Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thromb J 2016; 14:42. [PMID: 27708553 PMCID: PMC5039801 DOI: 10.1186/s12959-016-0117-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/05/2016] [Indexed: 01/15/2023] Open
Abstract
Disseminated intravascular coagulation (DIC) is a serious disease that, in the presence of underlying disease, causes persistent, generalized, marked coagulation activation. Early treatment based on an appropriate diagnosis is very important for improving patients’ prognosis, to which end diagnostic criteria play a key role. Several criteria have been proposed, but each has its strengths and weaknesses, and improved criteria are needed. Widespread use of coagulofibrinolytic markers has elucidated that the pathology of DIC differs greatly as a function of the underlying disease. Thus, discriminating use of DIC diagnostic criteria that take underlying diseases into account is important. DIC diagnostic criteria that are well known in Japan include the Japanese Ministry of Health and Welfare’s old DIC diagnostic criteria (JMHW criteria), the International Society on Thrombosis and Haemostasis’s DIC diagnostic criteria (ISTH criteria), and the Japanese Association for Acute Medicine’s acute-stage DIC diagnostic criteria (JAAM criteria). Those criteria have their respective drawbacks: the sensitivity of the ISTH criteria is poor, the JAAM criteria cannot be applied to all underlying diseases, and the JMHW criteria have poor sensitivity in the case of infections, do not use molecular markers, and result in misdiagnosis. The Japanese Society on Thrombosis and Hemostasis’s newly proposed provisional draft DIC diagnostic criteria (new criteria) use diagnostic criteria classifications of “hematopoietic disorder type”, “infectious type”, and “basic type” based on the underlying pathology. For the hematopoietic disorder type the platelet count is omitted from the score, while for the infectious type, fibrinogen is omitted from the score. Also, points are added if the platelet count decreases with time. In the new criteria, molecular markers and antithrombin activity have been newly included, and as a countermeasure for misdiagnosis, 3 points are deducted if there is liver failure. In this paper, we discuss various problems encountered with DIC diagnosis, and we describe the new criteria together with the events that led to their creation. These new diagnostic criteria take into account the underlying diseases of wide area, and we expect that they will serve clinicians well due to the above adaptations and improvements.
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Haram K, Mortensen JH, Mastrolia SA, Erez O. Disseminated intravascular coagulation in the HELLP syndrome: how much do we really know? J Matern Fetal Neonatal Med 2016; 30:779-788. [PMID: 27181089 DOI: 10.1080/14767058.2016.1189897] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The rate of disseminated intravascular coagulation (DIC) during pregnancy varies among nations from 0.03% to 0.35%. The existing reports suggest dissimilarity in the underlying mechanisms leading to DIC during gestation. While in developing countries preeclampsia and the HELLP syndrome are prevalent causes of DIC, the leading causes in the developed countries are placental abruption and postpartum hemorrhage. In different cohort studies, DIC is reported in about 12-14% of women with preeclampsia. Nevertheless, it has been suggested that in most cases these women also had a HELLP syndrome and that the occurrence of DIC in women who had only preeclampsia without manifestations of the HELLP syndrome is rare. The aims of this review are to: (1) highlight the mechanisms leading to DIC; (2) describe the changes in the coagulation system during this complication; and; (3) discuss the diagnostic tool and treatment modalities of DIC, in women who develop a HELLP syndrome.
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Affiliation(s)
- Kjell Haram
- a Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Jan Helge Mortensen
- b Department of Public Health and Primary Health Care , University of Bergen , Bergen , Norway
| | - Salvatore Andrea Mastrolia
- c Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy , and.,d Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Offer Erez
- d Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
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Bagot C, Leishman E. Establishing a reference range for thrombin generation using a standard plasma significantly improves assay precision. Thromb Res 2015; 136:139-43. [DOI: 10.1016/j.thromres.2015.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
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Lipets EN, Ataullakhanov FI. Global assays of hemostasis in the diagnostics of hypercoagulation and evaluation of thrombosis risk. Thromb J 2015; 13:4. [PMID: 25635172 PMCID: PMC4310199 DOI: 10.1186/s12959-015-0038-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/12/2015] [Indexed: 01/12/2023] Open
Abstract
Thrombosis is a deadly malfunctioning of the hemostatic system occurring in numerous conditions and states, from surgery and pregnancy to cancer, sepsis and infarction. Despite availability of antithrombotic agents and vast clinical experience justifying their use, thrombosis is still responsible for a lion’s share of mortality and morbidity in the modern world. One of the key reasons behind this is notorious insensitivity of traditional coagulation assays to hypercoagulation and their inability to evaluate thrombotic risks; specific molecular markers are more successful but suffer from numerous disadvantages. A possible solution is proposed by use of global, or integral, assays that aim to mimic and reflect the major physiological aspects of hemostasis process in vitro. Here we review the existing evidence regarding the ability of both established and novel global assays (thrombin generation, thrombelastography, thrombodynamics, flow perfusion chambers) to evaluate thrombotic risk in specific disorders. The biochemical nature of this risk and its detectability by analysis of blood state in principle are also discussed. We conclude that existing global assays have a potential to be an important tool of hypercoagulation diagnostics. However, their lack of standardization currently impedes their application: different assays and different modifications of each assay vary in their sensitivity and specificity for each specific pathology. In addition, it remains to be seen how their sensitivity to hypercoagulation (even when they can reliably detect groups with different risk of thrombosis) can be used for clinical decisions: the risk difference between such groups is statistically significant, but not large.
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Affiliation(s)
- Elena N Lipets
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Fazoil I Ataullakhanov
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia ; National Research Center for Hematology, Moscow, Russia ; Physics Department, Moscow State University, Moscow, Russia ; Federal Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia ; Faculty of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia ; HemaCore LLC, Moscow, Russia
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Swanepoel AC, Pretorius E. Erythrocyte-platelet interaction in uncomplicated pregnancy. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2014; 20:1848-1860. [PMID: 25470019 DOI: 10.1017/s1431927614013518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Maternal and fetal requirements during uncomplicated pregnancy are associated with changes in the hematopoietic system. Platelets and erythrocytes [red blood cells (RBCs)], and especially their membranes, are involved in coagulation, and their interactions may provide reasons for the changed hematopoietic system during uncomplicated pregnancy. We review literature regarding RBC and platelet membrane structure and interactions during hypercoagulability and hormonal changes. We then study interactions between RBCs and platelets in uncomplicated pregnancy, as their interactions may be one of the reasons for increased hypercoagulability during uncomplicated pregnancy. Scanning electron microscopy was used to study whole blood smears from 90 pregnant females in different phases of pregnancy. Pregnancy-specific interaction was seen between RBCs and platelets. Typically, one or more platelets interacted through platelet spreading and pseudopodia formation with a single RBC. However, multiple interactions with RBCs were also shown for a single platelet. Specific RBC-platelet interaction seen during uncomplicated pregnancy may be caused by increased estrogen and/or increased fibrinogen concentrations. This interaction may contribute to the hypercoagulable state associated with healthy and uncomplicated pregnancy and may also play a fundamental role in gestational thrombocytopenia.
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Affiliation(s)
- Albe C Swanepoel
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323;Arcadia 0007,South Africa
| | - Etheresia Pretorius
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323;Arcadia 0007,South Africa
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28
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Patel JP, Patel RK, Roberts LN, Marsh MS, Green B, Davies JG, Arya R. Changes in thrombin generation and D-dimer concentrations in women injecting enoxaparin during pregnancy and the puerperium. BMC Pregnancy Childbirth 2014; 14:384. [PMID: 25406658 PMCID: PMC4240885 DOI: 10.1186/s12884-014-0384-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/27/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is well accepted that the gravid state is hypercoagulable and a significant cause of both maternal morbidity and mortality in the Western world. Although thrombin generation is reported to be increased in pregnant women, uncertainty exists on the pattern of thrombin generation change during this time. The aim of this study is to describe thrombin generation changes and D-dimer concentrations in women injecting enoxaparin during pregnancy the postnatal period. METHODS One hundred and twenty-three women injecting enoxaparin had their thrombin generation, as measured by Calibrated Automated Thombinography (CAT), repeatedly assayed during pregnancy, once in each trimester, at delivery and 8 weeks post-partum. Furthermore, to understand the impact enoxaparin has on D-dimer concentrations during pregnancy, D-dimer concentrations were measured monthly in the recruited women. RESULTS Thrombin generation was found to increase in the first trimester (mean endogenous thrombin potential (ETP): 1391 nmol/L.min), further increasing during the second trimester (mean ETP: 1757 nmol/L.min), after which it plateaued through to delivery, where it peaked (mean ETP: 1857 nmol/L.min) and then fell back at 8 weeks post-partum (ETP: 1293 nmol/L.min). In contrast D-dimer concentrations increased exponentially during the antenatal period, despite the enoxaparin prescription. CONCLUSION Our results provide further evidence on alterations of thrombin generation during pregnancy and the postnatal period.
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Affiliation(s)
- Jignesh P Patel
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
- Institute of Pharmaceutical Science, King's College London, London, UK.
| | - Raj K Patel
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Lara N Roberts
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Michael S Marsh
- Department of Obstetrics and Gynaecology, King's College Hospital NHS Foundation Trust, London, UK.
| | | | - J Graham Davies
- Institute of Pharmaceutical Science, King's College London, London, UK.
| | - Roopen Arya
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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Dundar O, Pektas MK, Bodur S, Bakır LV, Cetin A. Recurrent pregnancy loss is associated with increased red cell distribution width and platelet distribution width. J Obstet Gynaecol Res 2014; 41:551-8. [DOI: 10.1111/jog.12600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Ozgur Dundar
- Department of Obstetrics and Gynecology; Haydarpasa Military Education and Research Hospital; GATA; Istanbul Turkey
| | - Mıne Kanat Pektas
- Depertment of Obstetrics and Gynecology; Kocatepe University School of Medicine; Afyon Turkey
| | - Serkan Bodur
- Department of Obstetrics and Gynecology and Dispensary of Oran; Beytepe Military Hospital; Ankara Turkey
| | - Lale Vuslat Bakır
- Department of Obstetrics and Gynecology; Haseki Education and Research Hospital; Istanbul Turkey
| | - Ahmet Cetin
- Department of Obstetrics and Gynecology; Haseki Education and Research Hospital; Istanbul Turkey
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