Plasminogen Activators, Plasminogen Activator Inhibitors and Markers of Intravascular Coagulation in Pre-Eclampsia

Koh, Sau; Anandakumar, C.; Montán, Sven; Ratnam, S. S.

doi:10.1159/000292703

Cited by 31 publications

(24 citation statements)

References 16 publications

(28 reference statements)

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“…However, Hazenedroglu et al (16) reported only elevated molecular markers of hemostatic activation in vivo in PE than in normal pregnancy and healthy subjects. This is in contrast with our earlier findings of enhanced coagulation and platelet activation in both normal pregnancy and preeclampsia compared to nonpregnant women (17). Gestational diabetes mellitus (GDM) is associated with both maternal and infant complications similar to those associated with pregnancy in women with established preexisting diabetes (18).…”

contrasting

confidence: 79%

The Influence of Labor and Placental Separation on Hemostasis in Term Pregnancy

Koh

Arulkumaran

Biswas

et al. 1998

Clin Appl Thromb Hemost

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We studied the hemostatic effects in 68 term preg nant subjects with normal pregnancy (n = 39), gestational diabetes mellitus (n = 21), pregnancy-induced hypertension (n = 8), during labor, after placental separation, and at 24 hours postpartum. During labor, a hypercoagulable state with en hanced fibrinolysis and platelet activation along with elevated plasminogen activator inhibitor-1 and plasminogen activator inhibitor-2 were seen. In all cases following placental separa tion, enhanced fibrinolysis persisted with further elevated tissue plasminogen activator antigen and D-dimer levels, increased thrombin generation and platelet activation with decreasing plasminogen activator inhibitor-1 levels. By 24 hours postpar tum, thrombin generation (thrombin-antithrombin complex) decreased to a nonpregnant level except for pregnancy induced hypertension, but enhanced prothrombin activation (F1+2) was evident in normal, gestational diabetes mellitus and pregnancy- induced hypertension. Reduced total protein S and antithrom bin III activity with normal protein C and elevated fibrinogen levels seen during labor were not affected by delivery. How ever, although factor VII showed a decreasing trend at 24 hours postpartum it remained elevated above the normal nonpregnant level. At 24 hours postpartum, a hypercoagulable state still persisted in normal, gestational diabetes mellitus and preg nancy-induced hypertension term pregnancy accompanied by enhanced fibrinolysis and elevated plasminogen substrate for fibrinolysis, suggesting a critical dynamic equilibrium between a thrombotic and hemorrhagic state.

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contrasting

confidence: 79%

The Influence of Labor and Placental Separation on Hemostasis in Term Pregnancy

Koh

Arulkumaran

Biswas

et al. 1998

Clin Appl Thromb Hemost

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“…These findings together with a raised t-PA antigen are similar to our earlier report on preeclampsia (Koh et al, 1993), a clinical condition associated with poor placental function, a wellcharacterised feature resulting from impaired fibrin clearance in the microcirculation of the placenta.…”

Section: Discussionsupporting

confidence: 90%

Plasminogen activators and inhibitors, D-dimer and β-TG in systemic lupus erythematosus pregnancy in relation to their obstetric outcome

Koh

Ratnam

et al. 1996

Journal of Obstetrics and Gynaecology

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We studied 52 systemic lupus erythematosus (SLE) pregnant patients (28 full term pregnancy, 15 pre-term delivery, eight abortions, and one intrauterine death for fibrinolytic and inhibitors status as compared with nortnal pregnancy. All patients were on prednisolone treatment before and during pregnancy. The elevated tissue plasminogen activator (t-PA) antigen and urokinase-like (u-PA) antigen levels in gestation matched SLE patients who aborted suggesting an enhanced endothelial release or tissue damage. The higher I)-dimer levels seen also indicate enhanced fibrinolysis resulting from endothelial release of plasminogen activators. In the SLE patient with an intra uterine death. a significantly elevated PAI-I activity (140 AUlml) and antigen (132 ng/ml) were seen. Like normal pregnancy, SLE pregnancy showed rising trends for antigen levels of t-PA, PAI-1, PAI-2. plasminogen and D-dinier. P-TG level was similar to normal pregnancy. However, unlike normal pregnancy significant reduction in antigen levels of u-PA, PAIL1 and PAI-2, and with elevated level of t-PA antigen were evident in SLE pregnancy. PAI-2 levels were significantly reduced from mid-trimester in the pre-term group whilst significant reduction was seen only in the third trimester of the full term group. These findings in SLE pregnancy with viable pregnancy outcome together with elevated t-PA antigen are similar to our earlier report on preeclampsia and suggest poor placental function. associated with microthrombosis and placental infarcts frequently seen in SLE-pregnancy.Correspotzdence rhould he ciddressed fo: Associate Professor 0. A. C. Viegas,

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“…Additionally, the impending development of CH did not appear to be associated with D-dimer levels. Interestingly, most studies have not identified a difference in D-dimer in PE compared with normal pregnancy, but these studies have not segregated for timing of onset of clinical disease [24, 26, 27, 33, 34]. D-dimer levels may be associated with severity of PE, since D-dimer is significantly increased in PE diagnosed before 34 weeks compared with PE diagnosed at a later gestational age or when compared to normal pregnancy [9].…”

Section: Discussionmentioning

confidence: 99%

Coagulation and fibrinolytic system protein profiles in women with normal pregnancies and pregnancies complicated by hypertension

Hale

Sobel

Benvenuto

et al. 2012

Pregnancy Hypertension: An International Journal of Women's Car

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Objective The current study longitudinally evaluated concentrations of fibrinogen (Fib), D-Dimer, plasminogen activator type-1 (PAI-1) and tissue type plasminogen activator (T-Pa) before pregnancy and in the first and third trimesters of pregnancy with a focus on the pregnancy transition. Study design Twenty healthy, nonsmoking, nulliparous women, aged 29.8 ± 3.0 years, BMI 23.3 ± 3.2 kg/m2 were studied during menstrual cycle day 8 ± 4 and again in early (11 – 15 wks) and late (31 – 34 wks) pregnancy. Seventeen women had singleton conceptions and delivered at term with uncomplicated pregnancies (CTL) and three women developed complicated hypertension (CH) during pregnancy after the third trimester (late pregnancy) evaluation. Data are means ± SEM, Significance was based on p < 0.05. Results Fib was the only protein evaluated that increased in early pregnancy relative to the prepregnancy assessment. D-dimer, PAI-1 and T-Pa increased in the third trimester compared with prepregnant and early pregnant values (p < .001). T-PA was significantly higher during late pregnancy in CH subjects compared with CTL (8.1 ± 0.7 ng/ml vs. 5.0 ± 0.2 ng/ml, p = .02). There were no other differences between groups. Conclusions Increases in fibrinogen are evident in early pregnancy whereas fibrinolysis, perhaps in response to the procoagulant environment of pregnancy, is increased during late pregnancy. Before development of clinically overt hypertension, T-Pa is increased without concomitant changes in other proteins assessed. This is consistent with altered endothelial function with preeclampsia that may contribute to, or reflect, the vasculopathy accompanying this disorder.

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Plasminogen Activators, Plasminogen Activator Inhibitors and Markers of Intravascular Coagulation in Pre-Eclampsia

Cited by 31 publications

References 16 publications

The Influence of Labor and Placental Separation on Hemostasis in Term Pregnancy

The Influence of Labor and Placental Separation on Hemostasis in Term Pregnancy

Plasminogen activators and inhibitors, D-dimer and β-TG in systemic lupus erythematosus pregnancy in relation to their obstetric outcome

Coagulation and fibrinolytic system protein profiles in women with normal pregnancies and pregnancies complicated by hypertension

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