Changes in fibrin D-dimer, fibrinogen, and protein S during pregnancy

Hansen, Anette Tarp; Andreasen, Birgitte Horst; Salvig, Jannie Dalby; Hvas, Anne‐Mette

doi:10.3109/00365513.2010.545432

Cited by 43 publications

(33 citation statements)

References 12 publications

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“…With advancing gestational age both PS and FPS levels decrease. It has been reported that lowest PS and FPS levels are reached in the second trimester and then a plateau is observed [4,23,24]. However, our study and other studies also showed that FPS levels continue to decrease modestly during the third trimester [5,25,26].…”

Section: Discussioncontrasting

confidence: 68%

Free Protein S Reference Ranges in Gravidas Without Hereditary and Acquired Thrombophilia

Başaran¹,

Deren

Büyükaşık

et al. 2014

Indian J Hematol Blood Transfus

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We carried out a retrospective cohort study to construct reference ranges for free protein S (FPS) levels during pregnancy and identify any conditions or factors that may affect FPS levels. Patients that were ordered thrombophilia screening tests during gestational period were identified. Patients demonstrated to have hereditary or acquired thrombophilia were excluded. Reference ranges were constructed using regression analysis. Outcome of the index pregnancy and pregnancy complications was used to identify any confounding factors. A total of 455 pregnant women were included. The quadratic equation for FPS according to gestational age (GA) was [75.497 + (-1.516*GA) + 0.018*GA*GA]. FPS level and GA were negatively correlated (Spearmans rho statistic [rs] = -0.436, p = 0.001). FPS level and fetal growth restriction (FGR) were negatively correlated ([rs] = -0.093, p = 0.049). FPS level and placental abruption were positively correlated ([rs] = 0.098, p = 0.039). Stepwise linear regression model constructed to predict FPS level with gestational age, placental abruption and FGR as the predictor variables. Gestational age was the only variable retaining statistically significant relation with FPS level (χ(2) = 0.216, df = 3, p = 0.001). FPS levels decrease significantly throughout gestation in gravidas without hereditary and/or acquired thrombophilias. In patients without thrombophilia FPS levels are not associated with pregnancy complications. The obtained reference intervals may be useful for the clinicians ordering FPS during pregnancy.

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Section: Discussioncontrasting

confidence: 68%

Free Protein S Reference Ranges in Gravidas Without Hereditary and Acquired Thrombophilia

Başaran¹,

Deren

Büyükaşık

et al. 2014

Indian J Hematol Blood Transfus

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“…17,33 However, both our study and previous studies show reduced protein S levels in vitamin K antagonist and oral contraceptive users in the absence of a known true (genetic) deficiency. 34,35 This reinforces the importance of avoiding the collection of blood for protein S measurements at moments when acquired deficiency can be present.…”

Section: Discussionmentioning

confidence: 72%

Protein S levels and the risk of venous thrombosis: results from the MEGA case-control study

Pintão¹,

Ribeiro

Bezemer

et al. 2013

Blood

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Key Points• Low free protein S and low total protein S levels could not identify subjects at risk for venous thrombosis in a population-based study.• Protein S testing and subsequent testing on PROS1 mutations should not be considered in unselected patients with venous thrombosis.In thrombophilic families, protein S deficiency is clearly associated with venous thrombosis. We aimed to determine whether the same holds true in a population-based casecontrol study (n 5 5317). Subjects were regarded protein S deficient when protein S levels were <2.5th percentile of the controls. Free and total protein S deficiency was not associated with venous thrombosis: free protein S < 53 U/dL, odds ratio [OR] 0.82 (95% confidence interval [CI], 0.56-1.21) and total protein S < 68 U/dL, OR 0.90 (95% CI, 0.62-1.31). When lower cutoff values were applied, it appeared that subjects at risk of venous thrombosis could be identified at levels <0.10th percentile of free protein S (<33 U/dL, OR 5.4; 95% CI, 0.61-48.8). In contrast, even extremely low total protein S levels were not associated with venous thrombosis. PROS1 was sequenced in 48 subjects with free protein S level <1st percentile (<46 U/dL), and copy number variations were investigated in 2718 subjects, including all subjects with protein S (free or total) <2.5th percentile. Mutations in PROS1 were detected in 5 patients and 5 controls reinforcing the observation that inherited protein S deficiency is rare in the general population. Protein S testing and PROS1 testing should not be considered in unselected patients with venous thrombosis. (Blood. 2013;122(18):3210-3219)

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“…[1][2][3] Early studies demonstrated that fibrinogen repletion corrected clot strength, based on viscoelastic blood testing using thromboelastography/thromboelastometry. 4 Normal fibrinogen levels are elevated during pregnancy, 5 and cases studies indicate that fibrinogen repletion may be effective in the treatment of postpartum hemorrhage. 6,7 Additionally, studies have been published, or are underway, that provide supporting evidence for the role of fibrinogen repletion for treating acquired coagulopathy.…”

Section: Introductionmentioning

confidence: 99%

How I use fibrinogen replacement therapy in acquired bleeding

Levy

Goodnough

2015

Blood

135

100

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Fibrinogen is a critical protein for hemostasis and clot formation. However, transfusion guidelines have variable recommendations for maintaining fibrinogen levels in bleeding patients. An increasing number of studies support the practice of fibrinogen replacement therapy for acquired coagulopathies, and additional studies are underway. Fibrinogen therapy can be administered with cryoprecipitate or fibrinogen concentrates, and clinical practice varies according to their availability and licensing status. Fibrinogen concentrate therapy has been studied in animal models and clinical trials and supports the critical role of fibrinogen repletion in bleeding patients. Point-of-care testing will have an important role in guiding fibrinogen replacement for hemostatic therapy in clinical settings such as cardiovascular surgery, postpartum hemorrhage, and trauma. Fibrinogen therapy is an important component of a multimodal strategy for the treatment of coagulopathic bleeding.

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Changes in fibrin D-dimer, fibrinogen, and protein S during pregnancy

Cited by 43 publications

References 12 publications

Free Protein S Reference Ranges in Gravidas Without Hereditary and Acquired Thrombophilia

Free Protein S Reference Ranges in Gravidas Without Hereditary and Acquired Thrombophilia

Protein S levels and the risk of venous thrombosis: results from the MEGA case-control study

How I use fibrinogen replacement therapy in acquired bleeding

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