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Stanciakova L, Dobrotova M, Holly P, Zolkova J, Vadelova L, Skornova I, Ivankova J, Samos M, Bolek T, Grendar M, Danko J, Kubisz P, Stasko J. How can Secondary Thromboprophylaxis in High-Risk Pregnant Patients be Improved? Clin Appl Thromb Hemost 2022; 28:10760296211070004. [PMID: 35225706 PMCID: PMC8894622 DOI: 10.1177/10760296211070004] [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: 12/03/2022] Open
Abstract
Low-molecular-weight heparin (LMWH) is suggested for thromboprophylaxis in
pregnant women with previous venous thromboembolism (VTE). Anyway,
there is only limited amount of studies evaluating the effect of LMWH on
hemostatic parameters during pregnancy of patients with previous VTE and the
need of secondary thromboprophylaxis. We therefore provide results of
prospective and longitudinal assessment of changes in hemostasis in high-risk
pregnant women at four times during pregnancy (T1–T4) and one time after the
postpartum period (T5) used for individualized modification of
thromboprophylaxis. In this study, the results of coagulation factor VIII
(FVIII) and protein S (PS) activity, ProC Global ratio and anti-Xa activity were
evaluated. Despite the thromboprophylaxis, an increased predisposition to
thromboembolic complications was detected (significant increase in FVIII
activity and decrease in PS function, ProC Global ratio not normalized even
after the postpartum period – p < .0001 between controls and
T5 for PS and ProC Global). These results indicate that hemostasis may not be
restored even 6 to 8 weeks after delivery and pose the question when is it safe
to withdraw the anticoagulant thromboprophylaxis in high-risk patients with
prior VTE.
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Affiliation(s)
- Lucia Stanciakova
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Miroslava Dobrotova
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Pavol Holly
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Jana Zolkova
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Lubica Vadelova
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic.,Center of Immunology in Martin, s.r.o., Martin, Slovak Republic
| | - Ingrid Skornova
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Jela Ivankova
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Matej Samos
- Department of Internal Medicine I., Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Tomas Bolek
- Department of Internal Medicine I., Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Marian Grendar
- Laboratory of Bioinformatics and Biostatistics, Biomedical Center Martin, Comenius University in Bratislava, 112842Jessenius Faculty of Medicine in Martin, Martin, Slovak Republic.,Laboratory of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Karlova Ves, Slovak Republic
| | - Jan Danko
- Department of Gynecology and Obstetrics, 112842Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovak Republic
| | - Peter Kubisz
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
| | - Jan Stasko
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusion Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin University Hospital, Martin, Slovak Republic
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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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Orita Y, Hamada T, Togami S, Douchi T, Kobayashi H. The Optimal Cutoff Level of D-Dimer during Pregnancy to Exclude Deep Vein Thrombosis, and the Association between D-Dimer and Postpartum Hemorrhage in Cesarean Section Patients. Kurume Med J 2021; 66:107-114. [PMID: 34135198 DOI: 10.2739/kurumemedj.ms662003] [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: 11/23/2022]
Abstract
OBJECTIVE The main purpose was to clarify the optimal D-dimer cutoff level during pregnancy to exclude deep vein thrombosis (DVT) prior to Cesarean section. The secondary purpose was to determine whether D-dimer can predict severe postpartum hemorrhage (PPH) in Cesarean section patients. METHODS Two hundred and seventy eight elective Cesarean section cases were enrolled. Clinical factors and blood parameters at 34-37 weeks of gestation were analyzed. To detect DVT, lower extremities veins were examined using color Doppler ultrasonography in cases with D-dimer level ≥ 1.5 μg/mL. In addition, postpartum blood loss amounts during Cesarean section were recorded. RESULTS Five DVT cases occurred in 250 singleton pregnancies, and 2 DVT cases occurred in 28 twin pregnancies. The overall incidence of DVT was 2.5%. The D-dimer level was higher in DVT cases than in non-DVT cases (3.84±1.97 vs. 2.31±1.48 μg/mL, P<0.01). The optimal D-dimer cutoff level was 2.6 μg/mL with a negative predic tive value of 99.5%, and sensitivity of 85.7%. PPH during Cesarean section was positively correlated with D-dimer level in all pregnancies. However, this relationship disappeared after excluding twin pregnancies. CONCLUSION A D-dimer level < 2.6 μg/mL at 34-37 weeks of gestation has the potential to exclude DVT. D-dimer can be an independent predictor for severe PPH for all Cesarean section cases, including twin pregnancies.
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Affiliation(s)
- Yuji Orita
- Department of Obstetrics and Gynecology, Kanoya Medical Center.,Department of Obstetrics and Gynecology Faculty of Medicine, Kagoshima University
| | - Tomonori Hamada
- Department of Obstetrics and Gynecology Faculty of Medicine, Kagoshima University
| | - Shinichi Togami
- Department of Obstetrics and Gynecology Faculty of Medicine, Kagoshima University
| | - Tsutomu Douchi
- Department of Obstetrics and Gynecology Faculty of Medicine, Kagoshima University
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology Faculty of Medicine, Kagoshima University
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Olsson M, Stanne TM, Pedersen A, Lorentzen E, Kara E, MartinezâPalacian A, RÃnnow Sand NP, Jacobsen AF, Sandset PM, Sidelmann JJ, EngstrÃm G, Melander O, Kanse SM, Jern C. Genome-wide analysis of genetic determinants of circulating factor VII-activating protease (FSAP) activity. J Thromb Haemost 2018; 16:2024-2034. [PMID: 30070759 PMCID: PMC6485504 DOI: 10.1111/jth.14258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/17/2023]
Abstract
Essentials Knowledge of genetic regulators of plasma factor VII activating protease (FSAP) levels is limited. We performed a genome-wide analysis of variants influencing FSAP activity in Scandinavian cohorts. We replicated an association for Marburg-1 and identified an association for a HABP2 stop variant. We identified a novel locus near ADCY2 as a potential additional regulator of FSAP activity. SUMMARY Background Factor VII-activating protease (FSAP) has roles in both coagulation and fibrinolysis. Recent data indicate its involvement in several other processes, such as vascular remodeling and inflammation. Plasma FSAP activity is highly variable among healthy individuals and, apart from the low-frequency missense variant Marburg-I (rs7080536) in the FSAP-encoding gene HABP2, determinants of this variation are unclear. Objectives To identify novel genetic variants within and outside of the HABP2 locus that influence circulating FSAP activity. Patients/Methods We performed an exploratory genome-wide association study (GWAS) on plasma FSAP activity amongst 3230 Swedish subjects. Directly genotyped rare variants were also analyzed with gene-based tests. Using GWAS, we confirmed the strong association between the Marburg-I variant and FSAP activity. HABP2 was also significant in the gene-based analysis, and remained significant after exclusion of Marburg-I carriers. This was attributable to a rare HABP2 stop variant (rs41292628). Carriers of this stop variant showed a similar reduction in FSAP activity as Marburg-I carriers, and this finding was replicated. A secondary genome-wide significant locus was identified at a 5p15 locus (rs35510613), and this finding requires future replication. This common variant is located upstream of ADCY2, which encodes a protein catalyzing the formation of cAMP. Results and Conclusions This study verified the Marburg-I variant to be a strong regulator of FSAP activity, and identified an HABP2 stop variant with a similar impact on FSAP activity. A novel locus near ADCY2 was identified as a potential additional regulator of FSAP activity.
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Affiliation(s)
- M. Olsson
- Department of Pathology and GeneticsInstitute of BiomedicineThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - T. M. Stanne
- Department of Pathology and GeneticsInstitute of BiomedicineThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - A. Pedersen
- Department of Pathology and GeneticsInstitute of BiomedicineThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - E. Lorentzen
- Bioinformatics Core FacilityUniversity of GothenburgGothenburgSweden
| | - E. Kara
- Institute of Basic Medical SciencesFaculty of MedicineUniversity of OsloOsloNorway
| | - A. MartinezâPalacian
- Institute of Basic Medical SciencesFaculty of MedicineUniversity of OsloOsloNorway
| | - N. P. RÃnnow Sand
- Department of CardiologyHospital of South West DenmarkEsbjerg and Department of Regional Health ResearchFaculty of Health ScienceUniversity of Southern DenmarkEsbjergDenmark
| | - A. F. Jacobsen
- Department of ObstetricsOslo University Hospital and University of OsloOsloNorway
| | - P. M. Sandset
- Department of HematologyOslo University Hospital and University of OsloOsloNorway
| | - J. J. Sidelmann
- Unit for Thrombosis ResearchDepartment of Regional Health ResearchFaculty of Health ScienceUniversity of Southern DenmarkEsbjergDenmark
| | - G. EngstrÃm
- Department of Clinical Sciences, MalmÃLund UniversityLundSweden
| | - O. Melander
- Department of Clinical Sciences, MalmÃLund UniversityLundSweden
| | - S. M. Kanse
- Institute of Basic Medical SciencesFaculty of MedicineUniversity of OsloOsloNorway
| | - C. Jern
- Department of Pathology and GeneticsInstitute of BiomedicineThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
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Franchini M, Dentali F. Recurrent venous thromboembolism: a role for ABO blood group? Thromb Haemost 2017; 110:1110-1. [DOI: 10.1160/th13-09-0780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 11/05/2022]
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Swanepoel AC. Clinical relevance of fibrin fiber diameter during different phases of pregnancy. Microsc Res Tech 2016; 79:959-965. [PMID: 27447949 DOI: 10.1002/jemt.22727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/24/2016] [Accepted: 07/05/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Pregnancy-related deep vein thrombosis (DVT) is most common during the late phase of pregnancy and the first 6-weeks postpartum. Pregnancy-related DVT can have long-term complications, specifically post-thrombotic syndrome (PTS). Fibrin network ultrastructure is altered during pregnancy and post-partum. It is therefore essential to evaluate fibrin fiber diameter during and after pregnancy as this may provide insight into pregnancy-related DVT and subsequent PTS. MATERIALS AND METHODS The fibrin network ultrastructure of females during different phases of pregnancy was compared to that of non-pregnant females to assess possible changes to the fibrin network morphology and fibrin fiber diameter using scanning electron microscopy micrographs. RESULTS The fibrin network arrangement was more densely packed during different phases of pregnancy, corresponding to earlier findings. Fibrin diameter decreased significantly during pregnancy, with the greatest decrease occurring during the late phase of pregnancy. The fractal dimensions of fibrin micrographs increased significantly during pregnancy compared to nonpregnant females. These changes are indicative of a simultaneous hypercoagulable and hypofibrinolytic state and correspond to the increased risk of DVT and subsequent development of PTS. CONCLUSION It is critical to identify "vulnerable" females with an inflammatory predisposition to prevent possible DVT and subsequent PTS. Modifiable risk factors like obesity and smoking should be addressed to alleviate the burden on the coagulation system. Morphological and viscoelastic techniques are crucial in assessing the coagulatory health of females during pregnancy.
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Affiliation(s)
- Albe C Swanepoel
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
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Wang Y, Gao J, Du J. D-dimer concentration outliers are not rare in at-term pregnant women. Clin Biochem 2016; 49:688-691. [PMID: 26807989 DOI: 10.1016/j.clinbiochem.2016.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the D-dimer levels in pregnant women at term and the differences between pregnant women with different D-dimer levels. DESIGN AND METHODS The plasma D-dimer concentrations in pregnant women at term were identified in a cross-sectional study. The clinical indicators that are potentially relevant to D-dimer levels were compared between the pregnant women with different D-dimer levels (i.e., normal, mildly increased, and severely increased). RESULTS There were always some D-dimer concentration outliers in the pregnant women at term regardless of the presence or absence of complications, and there were no significant differences in maternal age, gestational age, gravidity, parity, blood count, blood coagulation, or liver function between the pregnant women with different D-dimer levels. CONCLUSIONS D-dimer levels may vary significantly during pregnancy for unknown reasons. This variation, particularly in pregnant women at term, might lead to questionable diagnostic information regarding coagulation.
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Affiliation(s)
- Yu Wang
- Department of Gynecology and Obstetrics of the Affiliated ShengJing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, China
| | - Jie Gao
- Department of Anatomy in Preclinical Medicine College of China Medical University, No. 92 North Second Road, Heping District, Shenyang, China
| | - Juan Du
- Department of Gynecology and Obstetrics of the Affiliated ShengJing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, China.
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Wik HS, Jacobsen AF, Mowinckel MC, Sandset PM. The role of inflammation in post-thrombotic syndrome after pregnancy-related deep vein thrombosis: A population-based, cross-sectional study. Thromb Res 2015; 138:16-21. [PMID: 26826503 DOI: 10.1016/j.thromres.2015.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Previous studies suggest that inflammation may play a role in the pathophysiology of post-thrombotic syndrome (PTS). The aims of the present study were to evaluate markers of inflammation as possible predictors for PTS after pregnancy-related deep vein thrombosis (DVT). We included 182 women with a pregnancy-related DVT during 1990-2003 and 314 controls. All women answered a questionnaire and donated a blood sample in 2006. PTS was diagnosed when a self-reported Villalta score was above 4. The following predictors of PTS were included: high sensitivity C-reactive protein (hsCRP), interleukin (IL)-6, IL-8, IL-10, monocyte chemotactic protein (MCP)-1, transforming growth factor (TGF)-β1, platelet derived growth factor (PDGF)-BB, and the two adhesion molecules intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1. High values were defined as above median value among controls. We found that 41% of cases were diagnosed with PTS 3-16years after index pregnancy. In univariate analyses, high values of hsCRP, IL-6, and IL-10 were significantly associated with PTS with ORs 2.3 (95% CI; 1.2-4.2, p=0.008), 1.9 (1.0-3.5, p=0.04), and 10.8 (1.3-89.8, p=0.01), respectively. Only hsCRP, which has previously been found to be independently associated with PTS, was independently associated with PTS in a multivariate logistic regression model, when adjusting for proximal DVT occurring postpartum, age above 33years, and smoking (adjusted OR 2.4; 95% CI 1.2-4.8, p=0.01). We conclude that hsCRP was associated with PTS 3-16years after pregnancy-related DVT.
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Affiliation(s)
| | - Anne Flem Jacobsen
- Oslo University Hospital, Department of Obstetrics and Gynaecology, Oslo, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
| | - Marie-Christine Mowinckel
- Oslo University Hospital, Department of Haematology, Oslo, Norway; Oslo University Hospital, Research Institute of Internal Medicine, Oslo, Norway.
| | - Per Morten Sandset
- Oslo University Hospital, Department of Haematology, Oslo, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway; Oslo University Hospital, Research Institute of Internal Medicine, Oslo, Norway.
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Glintborg D, Sidelmann JJ, Altinok ML, Mumm H, Andersen M. Increased thrombin generation in women with polycystic ovary syndrome: A pilot study on the effect of metformin and oral contraceptives. Metabolism 2015; 64:1272-8. [PMID: 26194691 DOI: 10.1016/j.metabol.2015.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is associated with risk factors for cardiovascular disease (CVD) which may be modified by the use of metformin and oral contraceptives (OC). Thrombin generation (TG) measures are risk markers of CVD and address the composite of multiple factors that influence blood coagulation. This prospective, randomized, intervention study evaluated the potential influence of PCOS on TG measures and the effect of OC and/or metformin on TG measures in women with PCOS. MATERIAL AND METHODS Ninety patients with PCOS and 35 controls were included. Patients were randomized to 12 months of treatment with metformin, metformin+OC or OC alone. C-reactive protein (CRP), fibrinogen, total cholesterol, trunk fat mass, body mass index, estradiol, testosterone, sex hormone binding globulin (SHBG) as well as TG measures, i.e. the lag time for formation of thrombin, the endogenous thrombin potential (ETP), peak thrombin concentration (peak) and time to peak were determined at baseline and after 12 months of treatment. RESULTS CRP and total testosterone were significantly higher and SHBG significantly lower in PCOS women than in controls (P=0.012, P<0.001 and P=0.008, respectively). The TG measures ETP, peak and lag time were increased in women with PCOS compared to controls (P<0.01). Significant correlations were observed between TG measures and fibrinogen, CRP, SHBG and fat trunk mass (P>0.01). ETP (P=0.006), peak (P=0.003) and lag time (P=0.023) remained increased after adjustment for these potential confounders. Treatment with OC and metformin+OC further increased ETP (P<0.001) and peak (P<0.005) and reduced time to peak (P<0.04). The increase in ETP was significantly lower in the metformin+OC group than in the OC group (P<0.05). Metformin alone did not affect TG significantly. CONCLUSIONS PCOS is associated with increase in TG measures independent of other risk factors of CVD. OC increase TG measures further and may thus add to the increased risk of CVD already present in women with PCOS.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000 Odense C, Denmark
| | - Johannes J Sidelmann
- Unit for Thrombosis Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, 6700 Esbjerg, Denmark.
| | - Magda Lambaa Altinok
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000 Odense C, Denmark
| | - Hanne Mumm
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000 Odense C, Denmark
| | - Marianne Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000 Odense C, Denmark
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Kjellberg U, van Rooijen M, Bremme K, Hellgren M. Increased activation of blood coagulation in pregnant women with the Factor V Leiden mutation. Thromb Res 2014; 134:837-45. [DOI: 10.1016/j.thromres.2014.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 07/09/2014] [Accepted: 07/31/2014] [Indexed: 12/11/2022]
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Joly B, Barbay V, Borg JY, Le Cam-Duchez V. Comparison of markers of coagulation activation and thrombin generation test in uncomplicated pregnancies. Thromb Res 2013; 132:386-91. [PMID: 23962423 DOI: 10.1016/j.thromres.2013.07.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pregnancy is a well-established risk factor for venous thromboembolism, and is associated with a state of hypercoagulability or parameters of thrombin generation. Currently, there is a lack of consensual data on thrombin generation during pregnancy. This study aimed to find a sensitive and specific biological marker of coagulation activation and to identify parameters of thrombin generation. PATIENTS AND METHODS The population included 101 women with uncomplicated pregnancies. The objective of this study was to correlate thrombin generation test (measured at 5pM tissue factor, 4μM lipids and without thrombomodulin), with fibrinogen and markers of blood coagulation activation: D-dimer, prothrombin fragments 1+2 (F1+2), thrombin-antithrombin complexes (TAT) and fibrin monomer complexes (FMC) in these women. Internal quality control was performed in each set of experiments. RESULTS Fibrinogen, D-dimer, F1+2, and TAT concentrations increased significantly throughout pregnancy, and were correlated with term of pregnancy. In our study, thrombin generation seemed to increase early on, and then remained stable throughout normal pregnancy, in contrast with other markers of blood coagulation activation, excepting FMC. The latter are subject to large inter-individual variations, especially during second trimester. No correlation was demonstrated between thrombin generation parameters and other activation markers. CONCLUSION While markers of coagulation activation significantly increased during pregnancy, thrombin generation increased only early on and remains stable during pregnancy. Finding a sensitive and specific biological marker for vascular pregnancy complications, such as FMC and thrombin generation levels, requires further investigation.
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Affiliation(s)
- Berangere Joly
- Unit of Haemostasis, Rouen University Hospital, Rouen, France
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