Fibrinolytic response to venous occlusion and fibrin fragment D-dimer levels in normal and complicated pregnancy.
The fibrinolytic response to venous occlusion was assessed in 29 women with normal or complicated pregnancy, by measurements of total t-PA and free t-PA with specific ELISAs. The release of t-PA from the vessel wall was 11 +/- 9 ng/ml in non-pregnant women (mean +/- SD, n = 6) but was markedly reduced throughout pregnancy. Following venous occlusion, free t-PA increased by 12 +/- 11 ng/ml in non-pregnant women but remained below the detection limit of 2 ng/ml towards the end of pregnancy. A markedly reduced t-PA release with absence of free t-PA was also observed during late pregnancy in patients with insulin-dependent diabetes mellitus, intra-uterine growth retardation and pre-eclampsia. Plasma levels of fragment D-dimer of cross-linked fibrin were measured with a specific ELISA in 79 pregnant women. D-dimer levels were 129 +/- 36 ng/ml (mean +/- SD, n = 8) in non-pregnant women and increased to 400 +/- 170 ng/ml (n = 25) and 440 +/- 220 ng/ml (n = 22) during the second and third trimester of pregnancy respectively. Significantly higher levels than observed in uncomplicated third trimester pregnancies were found in 3 out of 6 diabetic and in 2 out of 7 pre-eclamptic women. It is concluded that the t-PA release after venous occlusion is significantly reduced during pregnancy. In addition, released t-PA is rapidly inhibited. The levels of fragment D-dimer increase during pregnancy, suggesting that, notwithstanding the marked impairment of the fibrinolytic response to venous occlusion, the fibrinolytic system remains functionally active.
Ballegeer
V
V
Center for Thrombosis and Vascular Research, University of Leuven, Belgium.
Mombaerts
P
P
Declerck
P J
PJ
Spitz
B
B
Van Assche
F A
FA
Collen
D
D
D003250:Constriction; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005342:Fibrinolysis; D006801:Humans; D011225:Pre-Eclampsia / Q000097:blood; D011247:Pregnancy / Q000097:blood*; D011248:Pregnancy Complications / Q000097:blood*; D011254:Pregnancy in Diabetics / Q000097:blood; D014680:Veins
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D