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Elevated fibrinogen, von Willebrand factor, and Factor VIII confer resistance to dilutional coagulopathy and activated protein C in normal pregnant women.
Tanaka, K A; Bharadwaj, S; Hasan, S; Judd, M; Abuelkasem, E; Henderson, R A; Chow, J H; Williams, B; Mazzeffi, M A; Crimmins, S D; Malinow, A M.
Afiliação
  • Tanaka KA; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: ktanaka@som.umaryland.edu.
  • Bharadwaj S; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Hasan S; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Judd M; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Abuelkasem E; Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
  • Henderson RA; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Chow JH; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Williams B; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Mazzeffi MA; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Crimmins SD; Department of Obstetrics, Gynaecology and Reproductive Services, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Malinow AM; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
Br J Anaesth ; 122(6): 751-759, 2019 Jun.
Article em En | MEDLINE | ID: mdl-30916034
BACKGROUND: Gestational changes in coagulation factor concentrations include elevations in fibrinogen, Factor VIII, and von Willebrand factor (vWF). We hypothesised that blood samples from term pregnant (TP) subjects are less prone to coagulation disturbances from haemodilution compared with those from non-pregnant (NP) females. METHODS: Blood samples were collected from 15 NP and 15 TP subjects. In vitro haemodilution with normal saline was assessed by modified Clauss fibrinogen assay, factor activity, flow-chamber assay, and thromboelastometry. The impact of human fibrinogen concentrate (hFC), cryoprecipitate, and vWF/Factor VIII (FVIII) concentrate replacement in diluted TP and NP blood was compared. Thrombin generation and activated protein C sensitivity were assessed. RESULTS: TP blood contained twice the concentrations of fibrinogen, FVIII, and vWF relative to NP blood (P<0.0001). Platelet thrombus formation (PTF) under flow was reduced by 99.2% and 69.2% in diluted NP and TP blood, respectively. Platelet thrombus formation was partially restored by adding vWF/FVIII, but not hFC or cryoprecipitate. Fibrin clot firmness approached the threshold of 10 mm in diluted NP blood, and clot firmness was effectively restored by hFC, but not by vWF/FVIII. In the presence of thrombomodulin, peak thrombin generation was decreased by 86.7% in NP plasma, but by 31.8% in TP plasma (P<0.0001 vs NP plasma), indicating reduced activated protein C sensitivity in TP plasma. Both elevated FVIII and haemodilution contributed to activated protein C insensitivity. CONCLUSIONS: Our in vitro model showed relative resistance of TP blood to dilutional coagulation changes with respect to platelet adhesion, fibrin polymerisation, and thrombin generation. Careful therapeutic monitoring for different pro-haemostatic agents in pregnant women is warranted.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Hematológicas na Gravidez / Transtornos da Coagulação Sanguínea / Fatores de Coagulação Sanguínea / Hemodiluição Tipo de estudo: Etiology_studies / Prognostic_studies Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Br J Anaesth Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Hematológicas na Gravidez / Transtornos da Coagulação Sanguínea / Fatores de Coagulação Sanguínea / Hemodiluição Tipo de estudo: Etiology_studies / Prognostic_studies Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Br J Anaesth Ano de publicação: 2019 Tipo de documento: Article