Trombofilias En Infertilidad

Thrombosis Research (2005) 115, 461 — 467

intl.elsevierhealth.com/journals/thre

Regular Article

Coagulation status, thrombelastography and complications occurring late in pregnancy
Fiona M. Miall, Paramjeet S. Deol, Tim A. Barnes, Karen Dampier, Christopher C. Watson, Christina A. Oppenheimer, K. John Pasi, Sue R. Pavord*
University Hospitals of Leicester NHS Trust, United KingdomReceived 15 March 2004; received in revised form 23 September 2004; accepted 27 September 2004 Available online 5 November 2004

KEYWORDS
Pregnancy; Thrombophilia; Thrombelastography

Abstract Introduction: There is much interest in the relationship between coagulation status and complications of pregnancy. The thrombelastograph (TEG) has been proposed as a useful, inexpensive tool to screenfor patients with hypercoagulable states. Materials and methods: We investigated 588 unselected pregnant women at booking, obtaining blood samples for TEG and thrombophilia investigation. Pregnancy outcome data was recorded. Results: We found significant correlations between TEG parameters and the Prothrombin time (PT) and Activated Partial Thromboplastin time (APTT) ( pb0.01) and with plasmaAntithrombin level ( pb0.01). There was no correlation between TEG and other thrombophilic defects (protein C, protein S, Factor V Leiden mutation, Prothrombin G20210A mutation, MTHFR C677T mutation and Lupus Anticoagulant). There was a significant association of TEG parameters with midtrimester loss (MTL) but not with other adverse pregnancy outcomes. Conclusions: The correlation between TEG and PT,APTT and antithrombin level supports its value in providing a global measure of haemostasis. Coagulation status at booking is associated with increased risk of MTL but not with complications occurring later in pregnancy. D 2004 Elsevier Ltd. All rights reserved.

Introduction
* Corresponding author. Tel.: +44 116 2586534; fax: +44 116 2585093. E-mail address: sp59@le.ac.uk (S.R. Pavord).Those who work in obstetric haematology are presented with the major challenge of interpret-

0049-3848/$ - see front matter D 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.thromres.2004.09.019

462 ing the expanding body of literature relating to thrombophilia and adverse outcomes of pregnancy, and applying this to everyday clinical practice. In 1985, Branch et al. [1] described theassociation between the acquired Antiphospholipid syndrome (APS) and recurrent fetal loss. Subsequently, APS has also been associated with complications occurring later in pregnancy, including preeclampsia, intrauterine growth retardation and placental abruption [2]. The relationship of heritable thrombophilia with fetal loss was then investigated in the multicentre EPCOT study of 571 women. Thisshowed positive correlation with antithrombin, protein C and protein S deficiencies but not with Factor V Leiden mutation [3]. In contrast, a recent meta-analysis of 31 studies of thrombophilic disorders and fetal loss found significant associations with Factor V Leiden and protein S deficiency; but not with the MTHFR mutation, protein C or antithrombin deficiency [4]. Kupferminc et al. [5]reported a three- to five-fold increased incidence of inherited thrombophilia defects in patients with late pregnancy complications in a case-control study, whereas a large UK population-based study concluded that five prothrombotic genotypes (including Factor V Leiden, Prothrombin G20210A and MTHFR C677T) are not associated with the development of preeclampsia or gestational hypertension [6].However, most of the existing evidence in this area has been derived from retrospective data and there is a real need for large prospective studies. Clearly, the aetiology of adverse complications of pregnancy is multifactorial in which the presence of a thrombophilic defect is just one factor in the dynamic fetomaternal haemostatic process. Therefore a blood test, which could reliably predict for a...