D‐dimer levels during delivery and the postpartum

Epiney, Manuella; Boehlen, Françoise; Boulvain, Michel; Reber, Guido; Antonelli, E.; Morales, Marta Colecha; Irion, Olivier; Moerloose, Philippe de

doi:10.1111/j.1538-7836.2004.01108.x

Cited by 101 publications

(61 citation statements)

References 21 publications

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“…The progressive increase in prenatal D-dimer levels during late gestation and the marked elevation soon after delivery seen in women with singleton pregnancies in this study were consistent with the results of earlier studies in singleton pregnancies Coagulation-fibrinolysis in twin pregnancies [9][10][11][12][13][14]. Our longitudinal study demonstrated that the prenatal plasma levels of D-dimer and FDP were consistently higher in women with twin pregnancies than in women with singleton pregnancies, although the deliveries took place approximately 2 weeks earlier in the twin group than in the singleton group.…”

Section: Discussionsupporting

confidence: 82%

Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies

Morikawa

Yamada

Turuga

et al. 2006

Journal of Perinatal Medicine

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Aims: To examine whether coagulation-fibrinolysis in late pregnancy in women with twin pregnancies is more pronounced than in women with singleton pregnancies. Patients and methods: The plasma levels of D-dimer, fibrinogen/fibrin degradation products (FDP), and fibrinogen, the platelet count, and the antithrombin activity were assessed from 3 weeks before delivery until postpartum day 7 in 48 women (24 singleton and 24 twin pregnancies) without preeclampsia who underwent cesarean sections. Results: Women with singleton or twin pregnancies gave birth at 37.3±1.2 weeks or 35.2±1.4 weeks, respectively. Compared with singleton mothers, prenatal D-dimer and FDP levels were consistently and significantly higher among women with twin pregnancies. A significantly larger proportion of twin mothers exhibited prenatal levels of D-dimer >5.0 μg/mL, FDP >10.0 μg/mL, fibrinogen <420 mg/mL and antithrombin activity <70%. In addition, prenatal antithrombin activity in plasma was significantly lower. Conclusions: Coagulation-fibrinolysis is more enhanced in women with twin gestation than in women with singleton gestation

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Section: Discussionsupporting

confidence: 82%

Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies

Morikawa

Yamada

Turuga

et al. 2006

Journal of Perinatal Medicine

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“…È noto che i livelli dei D-dimeri aumentano molto in gravidanza: tale incremento si registra dalle prime settimane di gestazione fino al termine della gravidanza e nel post-partum, indipendentemente dal tipo di parto (vaginale o cesareo) [8,9]. L'aumento dei livelli di D-dimeri non è correlato al rischio clinico di trombosi nelle donne in gravidanza [10] pertanto, in questa situazione, non è utile fare ricorso alla valutazione del D-dimero per la diagnosi di trombosi venosa profonda o tromboembolismo polmonare.…”

Section: Stato Ipercoagulabile Correlato Alla Gravidanzaunclassified

Hemostatic changes in pregnancy

Simioni

Campello

2013

RHC

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Normal pregnancy is associated with changes in all aspects of haemostasis, including increase in concentrations of most clotting factors, decreasing concentrations of some of the natural anticoagulants and diminishing fibrinolytic activity. These changes help in maintaining placental function during pregnancy but result in a state of hypercoagulability that may predispose to thrombosis and placental vascular complications. During pregnancy, the concentrations of coagulation factors V, VII, VIII, IX, X, XII and von Willebrand factor rise significantly, accompanied by a pronounced increase in fibrinogen levels which increases up to two-fold from non-pregnant levels. Furthermore, there is a decrease in physiological anticoagulants manifested by a significant reduction in protein S activity and by acquired activated protein C resistance. The overall fibrinolytic activity is impaired during pregnancy, but returns rapidly to normal following delivery. This is largely due to placental derived plasminogen activator inhibitor type 2 (PAI-2), which is present in substantial quantities during pregnancy. D-Dimer levels increase in pregnancy but are not thought to indicate intravascular coagulation as fibrinolysis is depressed. These D-Dimers may originate from the uterus. Finally, the platelet count decreases in normal pregnancy possibly due to increased destruction and haemodilution with a maximal decrease in the third trimester. Immediately after delivery there is an increase in platelet count, especially in patients undergoing cesarean section. During treatment of severe post-partum hemorrhage, it is absolutely essential to have the knowledge that the starting values of the platelets are very different as compared to a non-pregnant patient. Moreover, after delivery, also the levels of fibrinogen increase. Since the value of fibrinogen represents a crucial parameter for the management of acute bleeding, it is essential to administer the proper amount of fibrinogen in the case of postpartum hemorrhage. This aspect is emphasized especially in relation to the use of thromboelastography and for a correct interpretation of the results. Thromboelastogram profiles strongly depend on the amount of platelets and fibrinogen in whole blood. Protocols for thromboelastogram guided administration of hemocomponents and coagulation factor concentrates in cases of acute bleeding in pregnancy and post-partum are required.

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“…Results of a small pilot study suggest that a strategy involving serial CUS combined with a moderately sensitive D-Dimer assay is effective in excluding DVT in pregnant women (27). D-Dimer levels are often positive in the later stages of pregnancy, (28,29) lowering the utility of this test to rule out DVT. Research to develop algorithms to diagnose DVT in pregnant women is ongoing.…”

Section: Diagnostic Algorithm For Dvtmentioning

confidence: 99%

Diagnosis and treatment of deep-vein thrombosis and approach to venous thromboembolism in obstetrics and gynecology

Burgazlı¹,

Bilgin

Kavukçu³

et al. 2011

J Turkish German Gynecol Assoc

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Deep vein thrombosis (DVT) is a common condition in which the approach to its diagnosis has evolved over the years. Currently, an algorithm strategy combining pre-test probability, D-Dimer testing and compression ultrasound imaging allows for safe and convenient investigation of suspected lower-extremity thrombosis. Patients with low pre-test probability and a negative D-Dimer test result can have proximal DVT excluded without the need for diagnostic imaging. The mainstay of treatment of DVT is anticoagulation therapy, whereas interventions such as thrombolysis and placement of inferior vena cava filters are reserved for special situations. The use of low-molecular-weight heparin (LMW) allows for outpatient management of most patients with DVT. The duration of anticoagulation therapy depends on whether the primary event was idiopathic or secondary to a transient risk factor. More research is required to optimally define the factors that predict an increased risk of recurrent DVT to determine which patients can benefit from extended anticoagulant therapy. DVT is also a serious problem in the antenatal and postpartum period of pregnancy. Thromboembolic complications are the leading cause of both maternal and fetal morbidity and mortality. The incidence of venous thromboembolism during normal pregnancy is six-fold higher than in the general female population of childbearing age. The treatment of DVT during pregnancy deserves special mention, since oral anticoagulation therapy is generally avoided during pregnancy because of the teratogenic effects in the first trimester and the risk of fetal intracranial bleeding in the third trimester. LMW heparin is the treatment of choice for DVT during pregnancy. If acute DVT occurs near term, interrupting anticoagulation therapy may be hazardous because of the risk of pulmonary embolism. In this situation, placement of a retrievable inferior vena cava filter must be considered. However, there is no consensus as to what the appropriate dose should be and whether anti-Xa levels need to be monitored. (J Turkish-German Gynecol Assoc 2011; 12: 168-75) Key words: Venous thrombosis, heparin, low-molecular-weight: heparin, anticoagulants, partial thromboplastin time, thromboembolism in pregnancy Received: 30 Junuary, 2011 Accepted: 25 May, 2011 Derin ven trombozları (DVT), teşhis yaklaşımlarının yıllar içinde büyük değişimler ve gelişmeler gösterdiği sık karşılaşılan bir durumdur. Son zamanlarda, pre-test probabilite, D-Dimer testi ve kompresyon ultrason görüntülemesini kombine eden bir algoritma stratejisi, alt ekstremite trombozlarından şüphelenilen olgularda hem güvenli hem de kullanışlı araştırma imkanı sağlamaktadır. Pre-test probabilitesi düşük, D-Dimer testi negatif olan hastalarda diagnostik görüntülemeye ihtiyaç olmadan, proksimal DVT dışlanabilir. DVT tedavisinin dayanak noktası antikoagü-lasyon tedavisidir, bununla birlikte tromboliz ve inferiyor vena cava filtreleri gibi girişimler özel durumlara mahsus tedavilerdir. Düşük moleküler ağırlıklı heparin kullanımı DVT'...

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D‐dimer levels during delivery and the postpartum

Cited by 101 publications

References 21 publications

Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies

Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies

Hemostatic changes in pregnancy

Diagnosis and treatment of deep-vein thrombosis and approach to venous thromboembolism in obstetrics and gynecology

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