Fibrinolytic Response to Venous Occlusion and Fibrin Fragment D-Dimer Levels in Normal and Complicated Pregnancy

Author:

Ballegeer V1,Mombaerts P2,Declerck P J2,Spitz B1,Van Assche F A1,Collen D2

Affiliation:

1. The Department of Obstetrics and Gynecology, University of Leuven, Belgium

2. The Center for Thrombosis and Vascular Research, University of Leuven, Belgium

Abstract

SummaryThe fibrinolytic response to venous occlusion was assessed in 29 women with normal or complicated pregnancy, by measurements of total t-PA and free t-PA with specific ELISAs. The release of t-PA from the vessel wall was 11±9 ng/ml in nonpregnant women (mean ± SD, n = 6) but was markedly reduced throughout pregnancy. Following venous occlusion, free t-PA increased by 12 ± 11 ng/ml in non-pregnant women but remained below the detection limit of 2 ng/ml towards the end of pregnancy. A markedly reduced t-PA release with absence of free t-PA was also observed during late pregnancy in patients with insulin-dependent diabetes mellitus, intra-uterine growth ietaida-tion and pre-eclampsia.Plasma levels of fragment D-dimer of cross-linked fibrin were measured with a specific FITS A in 79 pregnant women. D-dimer levels were 129 ± 36 ng/ml (mean ± SD, n = 8) in non-pregnant women and increased to 400 ± 170 ng/ml (n = 25) and 440 ± 220 ng/ml (n – 22) during the second and third trimester of pregnancy respectively. Significantly higher levels than observed in uncomplicated third trimester pregnancies were found in 3 out of 6 diabetic and in 2 out of 7 pre-eclamptic women.It is concluded that the t-PA release after venous occlusion is significantly reduced during pregnancy. In addition, released t-PA is rapidly inhibited. The levels of fragment D-dimer increase during pregnancy, suggesting that, notwithstanding the marked impairment of the fibrinolytic response to venous occlusion, the fibrinolytic system remains functionally active.

Publisher

Georg Thieme Verlag KG

Subject

Hematology

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