D-Dimer levels at different stages of pregnancy in Australian women: A single centre study using two different immunoturbidimetric assays

Khalafallah, Alhossain A; Morse, Michael A.; Albarzan, Abdul-Majeed; Adams, Murray J.; Dennis, Amanda; Bates, Gerald; Robertson, Iain; Seaton, D. A.; Brain, Terry

doi:10.1016/j.thromres.2012.05.022

Cited by 24 publications

(20 citation statements)

References 20 publications

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“…This suggests that D-dimer has no practical diagnostic use in pregnancy if the threshold for abnormal of 0.55 mg/L is used (cut-off out of pregnancy). The obtained results from this study are in accordance with our previously reported study and studies that included different population of pregnant women [14][15][16][17][18].…”

Section: Discussionsupporting

confidence: 92%

“…However, investigation of D-dimer among healthy pregnant women in different populations showed gradual increase of D-dimer which correlates with the gestational age; however, reference range varied depending on the D-dimer test (type, its sensitivity and specificity) [14][15][16][17][18], while the data about thrombin generation in normal pregnancy were scarce and conflicting [19,20].…”

Section: Introductionmentioning

confidence: 99%

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Thrombin generation, D-dimer and protein S in uncomplicated pregnancy

Kovač¹,

Lalic-Cosic

Dmitrovic³

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Thrombin generation, D-dimer and protein S in uncomplicated pregnancy

Kovač¹,

Lalic-Cosic

Dmitrovic³

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Given that PE is accompanied by coagulopathies, it is probably not surprising that d -dimer levels are raised in PE (741–745), although this is true for many conditions (746), and some of the assays would bear improvement (747, 748). Needless to say, however, raised d -dimer levels are also a strong marker for infection (749, 750).…”

Section: Proteomic and Similar Biomarkers – Circulating And Placentalmentioning

confidence: 99%

A Dormant Microbial Component in the Development of Preeclampsia

Kell

Kenny

2016

Front. Med.

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Preeclampsia (PE) is a complex, multisystem disorder that remains a leading cause of morbidity and mortality in pregnancy. Four main classes of dysregulation accompany PE and are widely considered to contribute to its severity. These are abnormal trophoblast invasion of the placenta, anti-angiogenic responses, oxidative stress, and inflammation. What is lacking, however, is an explanation of how these themselves are caused. We here develop the unifying idea, and the considerable evidence for it, that the originating cause of PE (and of the four classes of dysregulation) is, in fact, microbial infection, that most such microbes are dormant and hence resist detection by conventional (replication-dependent) microbiology, and that by occasional resuscitation and growth it is they that are responsible for all the observable sequelae, including the continuing, chronic inflammation. In particular, bacterial products such as lipopolysaccharide (LPS), also known as endotoxin, are well known as highly inflammagenic and stimulate an innate (and possibly trained) immune response that exacerbates the inflammation further. The known need of microbes for free iron can explain the iron dysregulation that accompanies PE. We describe the main routes of infection (gut, oral, and urinary tract infection) and the regularly observed presence of microbes in placental and other tissues in PE. Every known proteomic biomarker of “preeclampsia” that we assessed has, in fact, also been shown to be raised in response to infection. An infectious component to PE fulfills the Bradford Hill criteria for ascribing a disease to an environmental cause and suggests a number of treatments, some of which have, in fact, been shown to be successful. PE was classically referred to as endotoxemia or toxemia of pregnancy, and it is ironic that it seems that LPS and other microbial endotoxins really are involved. Overall, the recognition of an infectious component in the etiology of PE mirrors that for ulcers and other diseases that were previously considered to lack one.

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“…D-dimer should not be used in isolation during pregnancy to rule out DVT, as levels increase with pregnancy progression and usually reach thresholds considered abnormal in nonpregnant individuals. 30 This, along with the unsuitability of Wells prediction rule in pregnant women, makes pretest probability assessment more difficult. Chan's LEFt clinical prediction tool, which uses 3 variables (symptoms in the left leg, calf circumference difference .2 cm, and first trimester presentation) is predictive of positive imaging for DVT in pregnant women and may be useful in the decisionmaking for further imaging in the case of a negative CUS.…”

Section: Dvtmentioning

confidence: 99%

Venous thromboembolism and stroke in pregnancy

McLean¹,

Cushman

2016

Hematology

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Pregnancy and the postpartum period substantially increase the risk for thrombotic events. Although the absolute risk for thrombosis is low, these events comprise a significant portion of maternal morbidity and mortality. The vast majority of such events are venous, although the risk for ischemic stroke also appears to be increased in pregnancy. This review will explore the overlapping and unique risk factors for venous and arterial thrombosis in pregnancy. Diagnosis and prevention will be discussed, and treatment will be briefly touched on. The benefit of using a multidisciplinary model in caring for pregnant women who have had a thrombotic event or who are at increased risk for thrombosis is a major focus of the review. Using the experience of our own Hematology and Obstetrics/Maternal Fetal Medicine shared care model, we discuss specific examples of when the use of such an approach is particularly valuable.

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D-Dimer levels at different stages of pregnancy in Australian women: A single centre study using two different immunoturbidimetric assays

Cited by 24 publications

References 20 publications

Thrombin generation, D-dimer and protein S in uncomplicated pregnancy

Thrombin generation, D-dimer and protein S in uncomplicated pregnancy

A Dormant Microbial Component in the Development of Preeclampsia

Venous thromboembolism and stroke in pregnancy

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