Abstract Number: PB0433
Meeting: ISTH 2020 Congress
Background: Women are at higher risk of venous thromboembolism (VTE) in pregnancy and postpartum. Current routine coagulation tests cannot discern the physiological hypercoagulability of pregnancy. Global coagulation assays (GCA) may be more representative of the coagulation process.
Aims: To evaluate the ability of GCA to detect the hypercoagulability of pregnancy and differentiate coagulability depending on VTE risk profile.
Methods: Women undergoing term elective Caesarean section were recruited. Pre-operative blood sample were collected for baseline blood tests and experimental testing with thromboelastography (TEG), thrombin generation using calibrated automated thrombography (CAT) and fibrin generation using the overall haemostatic potential assay (OHP). Citrated whole blood was used for TEG while platelet-poor plasma for CAT and OHP was obtained from double-centrifuged citrated whole blood. Data from 47 healthy non-pregnant women aged 18-45 years were used as controls.
Results: Sixty women with term singleton pregnancies were included. 41.7% (n=25) were obese (≥30kg/m2) at booking and 88.3% (n=53) were multiparous. All GCA parameters were significantly more hypercoagulable in pregnant women compared to normal controls (Table 1), particularly with increased maximum amplitude (clot strength) (71.5 vs 60.6 mm, p< 0.001), endogenous thrombin potential (1895.22 vs 1399.33 nM.min, p< 0.001) and fibrin generation (79.01 vs 55.87 units, p< 0.001). Pregnant women with booking BMI ≥30kg/m2 had significantly higher maximum amplitude compared to pregnant women of normal BMI (18.5-25kg/m2) (73.2 vs 66.1 mm, p< 0.001). Statistical significance was maintained after controlling for age, parity, smoking status and diabetes. GCA parameters did not differ when comparing women of high and intermediate VTE risk with women of low risk.
Conclusions: GCA are able to detect the hypercoagulability of pregnancy and may potentially correlate with obesity in the pregnant population. GCA hold promise as adjuncts to risk factor-based criteria for VTE thromboprophylaxis during pregnancy and the puerperium – larger prospective studies are required.
|Variable||Controls (n=47)||Pregnant women (n=60)||p-value|
|TEG||Maximum amplitude (mm)||60.6||71.5||<0.001|
|Lysis 30 (%)||0.6||0.0||<0.001|
|CAT||Endogenous thrombin potential (nM.min)||1399.3||1895.2||<0.001|
|Thrombin peak (nM)||240.0||320.9||<0.001|
|Velocity index (nM/min)||84.0||110.7||0.001|
|OHP||Overall haemostatic potential (U)||25.4||33.9||<0.001|
|Overall coagulation potential (U)||54.8||79.0||<0.001|
|Overall fibrinolysis potential (%)||53.9||56.1||0.022|
[Table 1 shows global coagulation assay parameters in pregnant women compared to normal controls]
To cite this abstract in AMA style:O'Keefe D, Nandurkar H, Ho P, Hui L, Lim HY. Evaluation of Global Coagulation Assays in Pregnancy [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/evaluation-of-global-coagulation-assays-in-pregnancy/. Accessed October 1, 2023.
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