Changes in blood coagulation and fibrinolysis during the puerperium

Ygge, J

doi:10.1016/s0002-9378(16)34134-5

Cited by 54 publications

(22 citation statements)

References 29 publications

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“…1,33,34 This fibrinolytic shut-down occurs despite the increased levels of plasminogen, as found in our and other studies. 11,[31][32][33] Conversely, the plasma levels of the protease inhibitor alpha2-antiplasmin during normal pregnancy was found to be both unchanged 35 and increased, 36,37 while in the present study we noted a slight decrease in the third trimester. These widely varying findings could be due to differences in assay techniques.…”

Section: Discussionsupporting

confidence: 84%

“…As with antithrombin III, the fluctuations in platelet counts, though statistically significant, were within the normal range for nonpregnant controls. The steady decline in fibrinolytic activity during pregnancy is believed to be due to both a placenta-derived inhibitor 1,11,[31][32][33] and progressive decrease of plasminogen activator release by endothelial cells. 1,33,34 This fibrinolytic shut-down occurs despite the increased levels of plasminogen, as found in our and other studies.…”

Section: Discussionmentioning

confidence: 99%

“…The steady decline in fibrinolytic activity during pregnancy is believed to be due to both a placenta-derived inhibitor 1,11,[31][32][33] and progressive decrease of plasminogen activator release by endothelial cells. 1,33,34 This fibrinolytic shut-down occurs despite the increased levels of plasminogen, as found in our and other studies. 11,[31][32][33] Conversely, the plasma levels of the protease inhibitor alpha2-antiplasmin during normal pregnancy was found to be both unchanged 35 and increased, 36,37 while in the present study we noted a slight decrease in the third trimester.…”

Section: Discussionmentioning

confidence: 99%

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Hemostasis in Pregnant Saudi Women

et al. 1990

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A cross-sectional study of various hemostatic variables was undertaken in women during the three trimesters of normal pregnancy. In the third trimester of pregnancy, there was significant elevation of plasma fibrinogen, 55%; factor VIII activities, 64%; factor VIII:ristocetin cofactor, 44% ; factor VIII-related antigen, 49% ; factor X, 9% ; and plasminogen, 19%, and a reduction of antithrombin III, 10%; alpha2-antiplasmin, 7%; and platelet count, 20%, compared with those values obtained in healthy nonpregnant controls. These fluctuations developed gradually during the first and second trimesters. Prothrombin time, partial thromboplastin time, thrombin time, and reptilase time were similar in pregnant women and nonpregnant controls. Platelet aggregation in response to adenosine diphosphate, collagen, adrenaline, and arachidonic acid was significantly reduced in pregnant women compared to controls. The reduced platelet aggregability in Saudi pregnant women may counterbalance the increased plasmatic coagulation potential, thereby minimizing the risk of thromboembolic disease during pregnancy.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hemostasis in Pregnant Saudi Women

et al. 1990

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“…The role of the platelets in the hemostat ic process during and after labor has not been profoundly studied. The publications are mainly concerned with the platelet count during pregnancy and postpartum [2,8,9,13,14,16,17]. The results of these studies are controversial, showing that platelet count increases, decreases or does not change during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Platelet Functions Before, During and After Labor

Sagi¹,

Creter²,

Goldman³

et al. 1981

Acta Haematol

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Platelet functions were evaluated in 20 healthy pregnant women in the last months of pregnancy, during labor, and 5–12 weeks after labor. The results showed an increased platelet count, bleeding time and nitroblue tetrazolium (NBT) test, as well as an increased plasma calcium level postlabor. ADP- and epinephrine-induced aggregation during labor was markedly decreased, followed by a statistically significant increase post-labor. These findings are in correlation with the high incidence of thromboembolic phenomena occurring postlabor.

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“…Low fibrinolytic activity was observed in pregnant women at later months of pregnan cy. Plasma plasminogen levels were, how ever, found to be raised during pregnancy (47). During labor, the fibrinolytic activity was still low, but after delivery it rapidly in creased.…”

Section: Exercise Injury and Pregnancymentioning

confidence: 99%

Physiology of Plasminogen: With Special Reference to Activation and Degradation

Takada

Takada²

1988

Pathophysiol Haemos Thromb

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Plasminogen is said to be synthesized in many organs, but the major source of its production is considered to be the liver. The production of plasminogen is observed in fetal life, but its plasma level is low in new born infants, rising rapidly to attain adult levels in about 13 weeks. The plasma levels do not change much with age. Although the fibrinolytic enzyme system is influenced by many factors such as hormones, exercise, emotion, age, sex, nutritional states etc., the plasma levels of plasminogen are relatively stable. In this presentation we would like to discuss three important subjects related to the physiology of plasminogen. The first subject is the activation pathway of the native form of plasminogen (Glu-plg) by various activators in the plasma or clotted plasma. Glu-plg was not easily activated by activators such as urokinase (UK) or tissue plasminogen activator (t-PA), but activated very easily in the presence of fibrin clot. In the presence of purified clot, Glu-plg was partly activated by activators to Glu-plasmin, but also converted to Lys-plg by preformed plasmin, subsequently being activated to plasmin. Glu-plg I (containing two carbohydrate chains) changed conformation more easily upon interaction with fibrin than Glu-plg II (containing one carbohydrate chain) and Glu-plg I was also more easily activated by activators than Glu-plg II. Although Glu-plg was hardly activated by activators in the plasma, Glu-plg was activated easily in the presence of plasma clot. Results of immunoblotting experiments indicated that Glu-plg was mainly activated by activators directly to plasmin, not via Lys-plg in contrast to purified systems. The second subject is the degradation of plasminogen by elastase. Plasminogen may be degraded by proteolytic enzymes such as cathepsin or elastase. The degradation of plasminogen by elastase is shown to give rise to K1 to K3, K4, and mini-pig (containing K5). We have shown that the degradation rate to Glu-plg by elastase increased in the presence of tranexamic acid, indicating that the conformational change of Glu-plg in the presence of tranexamic acid resulted in the exposure of the hydrophobic regions connecting K3, K4 and K5, thus making them accessible to elastase. Consequently, Lys-plg or conformationally altered Glu-plg (possibly bound to fibrin or FDP) is more easily degraded in vivo. The last subject is relationship between plasma plasminogen levels and fibrinolytic activity in various ages. Although plasma plasminogen levels do not change with age, the fibrinolytic activity lowers. We found that t-PA antigen levels increased, PA inhibitor levels decreased, and PA activity decreased with age. These results suggest that the major factor influencing the activity of fibrinolytic system is not plasminogen but other components such as PA, PA inhibitors or inhibitors of plasmin.

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Changes in blood coagulation and fibrinolysis during the puerperium

Cited by 54 publications

References 29 publications

Hemostasis in Pregnant Saudi Women

Hemostasis in Pregnant Saudi Women

Platelet Functions Before, During and After Labor

Physiology of Plasminogen: With Special Reference to Activation and Degradation

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