Enhanced Coagulation Activation in Preeclampsia: the Role of APC Resistance, Microparticles and Other Plasma Constituents

Marja J. Van Wijk; Kees Boer; René J. Berckmans; Joost C. M. Meijers; Joris A. M. van der Post; Augueste Sturk; Ed Van Bavel; Rienk Nieuwland

doi:10.1055/s-0037-1613231

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2002; 88(03): 415-420
DOI: 10.1055/s-0037-1613231

Review Article

Schattauer GmbH

Enhanced Coagulation Activation in Preeclampsia: the Role of APC Resistance, Microparticles and Other Plasma Constituents

Marja J. Van Wijk

¹Departments of Obstetrics and Gynecology, Amsterdam, The Netherlands

²Departments of Medical Physics, Amsterdam, The Netherlands

,

Kees Boer

¹Departments of Obstetrics and Gynecology, Amsterdam, The Netherlands

,

René J. Berckmans

³Departments of Clinical Chemistry, Amsterdam, The Netherlands

,

Joost C. M. Meijers

⁴Departments of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands

,

Joris A. M. van der Post

¹Departments of Obstetrics and Gynecology, Amsterdam, The Netherlands

,

Augueste Sturk

³Departments of Clinical Chemistry, Amsterdam, The Netherlands

,

Ed Van Bavel

²Departments of Medical Physics, Amsterdam, The Netherlands

,

Rienk Nieuwland

³Departments of Clinical Chemistry, Amsterdam, The Netherlands

› Institutsangaben

Abstract

Summary

Coagulation activation in pregnancy is further enhanced in preeclampsia. We investigated whether this results from increased thrombin generation by the plasma itself or its cell-derived microparticles. Plasma samples were obtained from preeclamptic, normal pregnant and nonpregnant women (each n = 10). Prothrombin fragment 1+2 (F₁₊₂) and thrombin-antithrombin complex (TAT) concentrations were increased in pregnancy and further increased in preeclampsia. In pregnancy and preeclampsia, increased activated protein C resistance occurred (APC sensitivity ratio: 3.3 ± 0.8 and 2.5 ± 0.8, both P < 0.001 vs. nonpregnant). In normal pregnant microparticle-free plasma the thrombin generation correlated with TAT (r = 0.84, P = 0.005) and APC resistance correlated with F₁₊₂ (r = 0.68, P = 0.04). In preeclampsia thrombin generation by plasma was increased (P = 0.005), independent of APC resistance. Thrombin generation by microparticles was similar in all groups, although different coagulation activation pathways were utilized, indicating that circulating microparticles are not directly involved in coagulation activation in pregnancy and preeclampsia. In contrast, APC resistance can explain coagulation activation in pregnancy, while enhanced coagulation activation in preeclampsia results, in part, from an increased thrombin generating capacity of plasma independent of APC resistance.

Keywords

Pregnancy - preeclampsia - coagulation - APC resistance - microparticles

Volltext

Referenzen

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