Reproductive Failure and Thrombophilia: Not Enough Evidence for a Tight Bond.

OBJECTIVES: The role of hereditary thrombophilia in reproductive failure (RF) is strongly debatable. In this retrospective single-center study, we analyzed pregnancy outcome in 175 women screened for thrombophilia after at least one event of RF. RESULTS: The prevalence of thrombophilia in our cohort was 33.4%. Pregnancy survival curves were not different according to severity (log-rank, p = 0.302) or type of thrombophilia (log-rank, p = 0.532). In total, 81.7% of 175 subsequent pregnancies were proceeded with LMWH. Concomitant use of ASA was prescribed in 75 pregnancies according to physician choice. The primary endpoint was live birth rate (LBR) that succeeded in 152/175 next pregnancies (86.8%) and late obstetric complications (LOBC) which occurred in 17/175 next pregnancies (9.8%). In logistic regression analysis, neither the severity nor the type of thrombophilia was important for any pregnancy outcome (LBR or LOBC). Considering therapeutic interventions, the use of LMWH ± ASA was not related to LBR or LOBC. The only factor inversely related to LBR was age above the cutoff value of 35.5 years (p = 0.049). CONCLUSIONS: Incidence of thrombophilia is increased among women with RF, but the severity or type of thrombophilia is not related to pregnancy outcome.

Changes in haemostatic and platelet activation markers in non-dipper hypertensive patients.

BACKGROUND: Non-dipper hypertensive patients are at increased risk for cardiovascular disease. Coagulation and fibrinolysis activation factors are considered as risk factors for cardiovascular disease. The aim of this study was to examine the relationship between the haemostatic and platelet activation markers and the non-dipping pattern in treated hypertensive patients. PATIENTS AND METHODS: Seventy-one treated hypertensive patients (53 with essential and 18 with secondary hypertension, due to chronic kidney disease-stage 4), aged 33 to 81 years (30 men), were classified as dippers and non-dippers, according to the presence or absence, respectively, of a decline of nocturnal average systolic blood pressure (BP) by more than 10% of the diurnal BP (non-dipping pattern) on 24-hour ambulatory BP monitoring. Plasma levels of factors VIII and IX, fibrinogen, prothrombin fragment 1 + 2, thrombin-antithrombin complex, protein C, plasmin-alpha-2 antiplasmin complex, D-dimer and platelet factor 4 were measured in all patients. RESULTS: Thirty-seven patients were classified as dippers and 34 as non-dippers. The percentages of patients with essential and with secondary hypertension were similar in the dippers and in the non-dippers groups (both P = 0.754). Multivariate analysis of variance showed statistically significant differences in all measured variables between dippers and non-dippers (P = 0.043). Plasma levels of factors VIII and IX, fibrinogen, prothrombin fragment 1 + 2, protein C, plasmin-alpha-2-antiplasmin complex, and D-dimers were significantly higher in non-dippers when compared to dippers (P < 0.05 for all). In contrast, there were no significant differences in plasma levels of thrombin-antithrombin complex (P = 0.955) and platelet factor 4 (P = 0.431) between the two groups. CONCLUSION: This study provides evidence that non-dipper treated hypertensive patients exhibit alterations in haemostasis, which may affect their cardiovascular risk.