[Dynamics of thrombin-antithrombin-III complex (TAT-III) and prothrombin fragments F1 + 2 during labour with and without aprotinin administration].
OBJECTIVE
The aim of this study was to determine if aprotinin could affect postpartal fibrinolysis when given at the latest 15 min before delivery and if there is a difference between normal delivery and caesarean section. Furthermore we wanted to examine if the thrombin-antithrombin-III-complex (TAT-III) and prothrombin fragments F1 + 2 changed in the peripartal period and if prethrombotic stages could be recognized.


METHODS
84 patients (15 - 44 years of age) have been examined (41 normal deliveries, 43 cesarean sections). After giving informed consent and randomization, 30 of these patients were administered 1 Mio KIE aprotinin (Trasylol(R)) at the latest 15 min before delivery (15 normal deliveries, 15 cesarean sections). The results of TAT-III, prothrombin fragments F1 + 2, factor VIII and partial thromboplastin-time (PTT) were collected shortly before and after delivery and 30 and 120 min after detachment of the placenta.


RESULTS
Normal deliveries without aprotinin showed a significant increase of TAT-III and an evident increase of prothrombin fragments F1 + 2. After administration of aprotinin this increase was significantly lower. The increase of TAT-III and prothrombin fragments F1 + 2 in patients with caesarean sections was evidently lower than in normal deliveries and was not influenced significantly by aprotinin. Factor VIII and partial thromboplastin time (PTT) showed no relevant changes in all study groups.


CONCLUSIONS
The consumption of coagulation and fibrinolysis factors induced by delivery of the child and detachment of the placenta can be reduced after administration of aprotinin given at the latest 10 - 18 min before partus. This could be used in therapy and prophylactic treatment in high-risk patients (e. g., pre-eclampsia, HELLP syndrome, etc.).
Kühnert
M
M
Klinik für Geburtshilfe und Perinatalmedizin der Universitätsklinik Marburg. dres-kuehnert@t-online.de
Stein
W
W
Woernle
F
F
Tekesin
I
I
Hellmeyer
L
L
Schmidt
S
S
D000293:Adolescent; D000328:Adult; D000990:Antithrombin III; D007611:Aprotinin / Q000008:administration & dosage*; D002585:Cesarean Section; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000517:prevention & control; D005167:Factor VII / Q000378:metabolism; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000097:blood*; D008297:Male; D010314:Partial Thromboplastin Time; D010446:Peptide Fragments / Q000097:blood*; D010447:Peptide Hydrolases / Q000097:blood*; D049590:Postpartum Period / Q000502:physiology; D011247:Pregnancy; D011292:Premedication; D011516:Prothrombin
D006490:Hemostatics; D010446:Peptide Fragments; C046193:antithrombin III-protease complex; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D005167:Factor VII; D011516:Prothrombin; D007611:Aprotinin; D010447:Peptide Hydrolases