The Relationship between Clinical Signs and Hypercoagulable State in Toxemia of Pregnancy

Abstract

The hypercoagulable state in patients with toxemia of pregnancy was investigated in comparison with normal pregnant women using new coagulation parameters, mainly thrombin-antithrombin III (TAT) complexes, Α₂-antiplasmin-plasmin complexes (PIP), and D-dimer FDP. When the patients were categorized by the classification of the WHO Study Group (1985), significant increases of TAT complexes and Α₂-PIP complexes with decreases of the ATIII level were observed in the groups with preeclampsia and severe gestational hypertensive disease as compared to normal pregnant women. A significant increase of D-dimer FDP was observed in a group with severe gestational hypertensive disease. Additionally, the relationship between clinical signs and the hypercoagulable state in the patients was analyzed using canonical correlation analysis as a multivariate analysis. The clinical signs and coagulation parameters had a significantly high correlation of Λ₁ = 0.7219, p < 0.01. The results showed that clinical signs were associated with simultaneous coagulation abnormalities. The indices obtained from the results of canonical correlation analysis, which were called the clinical index and the coagulation index, should be useful in evaluating the efficacy of anticoagulation therapy.

Preeclampsia is associated with low concentrations of protein Z

“…Normal pregnancy is characterized by an increased plasma concentration of protein Z [37], which has been proposed to be part of a compensatory mechanism for the increased concentration of factor X [37] and perhaps for the increased thrombin generation. Preeclampsia is associated with an exaggerated hypercoagulable state and excessive thrombin generation [1,25,38], as determined by higher maternal plasma concentrations of TAT complexes [25][26][27][28]39,40] and lower antithrombin III concentrations [41][42][43][44][45] than patients with normal pregnancies. Moreover, patients with PE who deliver preterm have a higher rate of thrombotic lesions in the decidua [9,20] and in the placental villi [23] than normotensive patients with indicated or spontaneous preterm delivery [20,23].…”

“…Thrombosis has been proposed as a mechanism of disease in preeclampsia (PE) [9][10][11][12][13], intrauterine growth restriction (IUGR) [13][14][15][16][17], stillbirth [18], recurrent pregnancy losses [19], and preterm delivery [20][21][22]. Evidence in support of this view includes: (1) an excessive rate of thrombotic lesions in the placental villi [23] and decidual vessels [20,23,24] in patients with these pregnancy complications, and (2) higher maternal plasma concentrations of thrombin-anti-thrombin (TAT) complexes in patients with PE [25][26][27][28] and small for gestational age (SGA) neonates [25].…”

Immunohistochemical Study of Annexin V Expression in Placentae of Preeclampsia

“…In contrast, inhibition of platelet aggregation by prostacyclin-like activity [3], inhibition of blood coagulation by thrombomodulin [4] and fibrinolysis by tissue plasminogen activator [5] play important roles in the regulation of blood coagulation in the placenta. It is known that coagulation abnormalities are present in preeclampsia [6]. Enhanced thrombin formation and endothelial damage are reported in patients with preeclampsia [7].…”

Blood Coagulation and Fibrinolysis in Eclamptic Patients and Their Correlation with the Clinical Signs

“…Terao et al [10] found a strong correlation between clinical parameters of preeclampsia and coagula tion activities. We also found an exaggerated form of coagulation and fibrinolytic activities in all the patients.…”

“…For correlation analysis, we calculated the clinical index (for edema, pro teinuria and systolic blood pressure) and coagulation index A (for AT III antigen, PIC and D dimer) as described by Terao et al [10]. We also did a canonical correlation analysis among the most important clinical parameters: level of consciousness at the time of admission, 98 Halim/Bhuiyan/Azim/Khatun/Kanayama/ Blood Coagulation and Fibrinolysis in El Maradny/Maehara/Hiroshi/Terao Eclamptic Patients Table 4.…”