Coagulation assessment by rotation thrombelastometry in normal pregnancy.
We analysed changes in coagulation during normal pregnancy with a novel point-of-care device based on thrombelastometry (ROTEM). We compared the results obtained with those of standard coagulation tests in 104 patients: 20 non-pregnant women (controls) and 84 women in the first (T1, n = 17), second (T2, n = 9) and third (T3, n = 58) trimesters of pregnancy. We measured the clotting time (CT), the maximum clot firmness (MCF), the early clot amplitude at 5 and 15 minutes (CA(5), CA(15)) and the clot lysis index (CLI(30)) with four tests containing specific reagents. (a) The INTEM test involving ellagic acid activated the intrinsic pathway and (b) the EXTEM test using tissue factor triggered the extrinsic pathway; (c) The FIBTEM test based on a platelet inhibitor (cytochalasin D) evaluated the contribution of fibrinogen to clot formation and (d) the APTEM test was similar to the EXTEM but was based on inhibition in vitro of fibrinolysis by aprotinin. CT and CLI(30) were not significantly modified during pregnancy whereas MCF, CA(5) and CA(15) (INTEM, EXTEM, FIBTEM) increased significantly between the second and third trimesters (e.g. median [interquartile range]: MCF-FIBTEM, 13 [11-16] mm vs. 19 [17-23] mm, respectively, in controls and T3, p < 0.001). EXTEM values were not significantly different from those measured with APTEM. There were significant correlations between the results obtained with ROTEM and those from standard coagulation tests. ROTEM analysis showed a marked increase in coagulability during normal pregnancy. ROTEM values may serve as the basis for future studies in pregnant women.
Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France. cyril.huissoud@chu-lyon.fr
Cyril
C
Huissoud
Nicolas
N
Carrabin
Mehdi
M
Benchaib
Oriane
O
Fontaine
Albrice
A
Levrat
Denis
D
Massignon
Sandrine
S
Touzet
René-Charles
RC
Rudigoz
Michel
M
Berland
D000328:Adult; D007611:Aprotinin; D001777:Blood Coagulation; D016022:Case-Control Studies; D015638:Cytochalasin D; D004610:Ellagic Acid; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis*; D011264:Pregnancy Trimesters / Q000097:blood; D011446:Prospective Studies; D011517:Prothrombin Time; D012016:Reference Values; D012399:Rotation; D013916:Thrombelastography; D013925:Thromboplastin; D013997:Time Factors; D055815:Young Adult
D006454:Hemoglobins; D004610:Ellagic Acid; D015638:Cytochalasin D; D005340:Fibrinogen; D013925:Thromboplastin; D007611:Aprotinin