Impact de l’âge maternel avancé sur les profils de coagulation thrombo-élastographique du péripatum: une étude observationnelle prospective exploratoire

Abstract

Purpose Advanced maternal age (AMA) is a known risk factor for pregnancy-related venous thromboembolism. However, it is unclear if underlying differences exist in the maternal coagulation profiles of AMA vs non-AMA women. The aim of this prospective observational study was to compare peripartum thromboelastography parameters of AMA and non-AMA women undergoing elective Cesarean delivery (CD). [25][26][27][28][29][30][31][32][33][34] yr in the AMA and non-AMA groups, respectively (P \ 0.001). We observed no statistically significant effect of study group on any thromboelastographic or laboratory coagulation parameters. No statistically significant correlations were found between any thromboelastographic parameter and maternal age. Peripartum thromboelastography and coagulation profiles of healthy AMA and healthy non-AMA women up to 72 hr post-CD were also similar. Conclusion These data suggest that maternal thromboelastographic profiles of healthy AMA and non-AMA women undergoing elective CD are similar. The study was registered at ClinicalTrials.gov (identifier: NCT01416454). Methods

Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH

“…Future studies need to test TEG or ROTEM with different low molecular weight heparins to determine ideal prophylactic doses to effectively reduce VTE risk after pregnancy. A study by Butwick et al 117 compared coagulation profiles of healthy pregnant women ≤ 35 years with women of advanced maternal age > 35 years, but found no significant correlations between any TEG variable and maternal age. This may have been due to lack of study power or it is possible that TEG may not be sensitive enough to detect subtle differences in maternal coagulability even though advanced maternal age is a known risk factor for thromboembolism 117 .…”

“…A study by Butwick et al117 compared coagulation profiles of healthy pregnant women ≤ 35 years with women of advanced maternal age > 35 years, but found no significant correlations between any TEG variable and maternal age. This may have been due to lack of study power or it is possible that TEG may not be sensitive enough to detect subtle differences in maternal coagulability even though advanced maternal age is a known risk factor for thromboembolism 117. More TEG/ROTEM studies are needed to assess other risk factors for VTE.Another area that has potential for viscoelastic testing, but needs to be further investigated is PPH.…”

Coagulation in the HIV-positive pregnant patient : a thromboelastography study

“…4 Regional anaesthesia is the technique of choice for CS in the parturient in the absence of contraindications, and has been shown to decrease morbidity and mortality in HIV-positive patients undergoing elective CS. 5,6 Thromboelastography (TEG) has been extensively utilised in previous studies to demonstrate the coagulation status of pregnant patients, 7,8 and the measured parameters influence the decision to perform regional or general anaesthesia for CS.…”