Classic and Global Hemostasis Testing in Pregnancy and during Pregnancy Complications

Abstract

Pregnancy is associated with a significant procoagulant shift in the hemostatic system balance as well as other metabolic changes. Pregnancy can thereby provoke manifestation of otherwise dormant disorders of hemostasis (e.g., thrombophilia), or even cause new, pregnancy-specific disorders (e.g., HELLP syndrome). Application and interpretation of laboratory assays of hemostasis in pregnancy is particularly challenging, because normal physiological ranges are no longer applicable, and because the most dangerous and complex changes are not detected by classic routine coagulation/platelet assays. New global assays of coagulation and of platelet-dependent hemostasis appear to be promising in this respect, but are still far from clinical practice and rarely appear in current patient management guidelines. These global assays require a high level of research to identify their relationship to clinically significant outcomes. Here, we review the state-of-the-art knowledge of the molecular changes in the hemostatic system in normal pregnancy and during pregnancy-related complications (preeclampsia, thrombotic microangiopathies, antiphospholipid syndrome, etc.). We also discuss the sensitivity of various classic and innovative assays to these pregnancy-associated changes, and describe current and potential future applications of these assays in meeting specific clinical needs.

An enhanced clot growth rate before in vitro fertilization decreases the probability of pregnancy

“…One week after ET, we observed an elevated clot growth velocity in women who achieved pregnancy (Table 3). This finding is consistent with the fact that even normal pregnancy is characterized by a shift in hemostasis towards a hypercoagulation state [25]. Similar results were obtained for thrombin generation, TEG and the factor VIII level in the study by Gerotziafas et al [42].…”

“…It is well known that global hemostasis assays are informative for the assessment of hypercoagulation in pregnancy [25]. A new global coagulation assessment, namely, thrombodynamics, seems to be suitable for both the detection of hypercoagulation and monitoring of anticoagulant prophylaxis or therapy [26–29], including the monitoring of anticoagulant prophylaxis in pregnancy [30].…”

The Effect Of Combined Oral Contraceptives And Hormone Therapy During Assisted Reproductive Technologies On The Function Of The Hemostatic System In Non-Pregnant And Pregnant Women

“…In the III trimester, late complications develop: antenatal fetal death (15%), preeclampsia (5%), placental insufficiency (5%), intrauterine growth retardation (2.5%). The majority of women with such pregnancy complications after taking COCs during the examination show congenital and / or acquired thrombophilia with the same frequency as in the population [22].…”

Аspects of the methodology of laboratory studies of hemostasis in pediatric hematology-oncology and general approaches in the pathology of hemostasis in leukemia

“…Лабораторные тесты для оценки состояния системы свертывания крови могут быть разделены на функциональные, характеризующие работу системы, индивидуальные (дифференциальные), характеризующие концентрацию или активность отдельных элементов системы, и маркерные, которые оценивают присутствие специфических маркеров процессов тромбообразования и фибринолиза [4]. Функциональные тесты, в свою очередь, подразделяются на субглобальные (к ним в основном относятся так назы-Г Е М АТ ОЛ О Г И И и О Н КОЛ О Г И И Д Е Т С КО Й оссийский Р урнал Ж 76 2018 ТОМ 5 3 О б з о р ы л и т е р а т у р ы ваемые классические тесты), которые характеризуют работу конкретного сегмента свертывающей системы, и глобальные (интегральные) тесты, цель которых наиболее полно охарактеризовать весь процесс тромбообразования приближенно к условиям свертывания в организме человека [2].…”