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Thromb Haemost 1997; 77(06): 1096-1103
DOI: 10.1055/s-0038-1656119
Clinical Studies
Schattauer GmbH Stuttgart

Prospective Evaluation of the Prevalence of Haemostasis Abnormalities in Unexplained Primary Early Recurrent Miscarriages

The Nímes Obstetricians and Haematologists (NOHA) Study
Jean-Christophe Gris
1   The Consultations et Laboratoire d’Hématologie, CHU, Nimes
2   Laboratoire d’Hématologie, Faculté de Pharmacie, Montpellier
,
Sylvie Ripart-Neveu
3   Service de Gynécologie-Obstétrique, CHU NTmes
,
Claude Maugard
1   The Consultations et Laboratoire d’Hématologie, CHU, Nimes
,
Marie-Laure Tailland
3   Service de Gynécologie-Obstétrique, CHU NTmes
,
Sophie Brun
1   The Consultations et Laboratoire d’Hématologie, CHU, Nimes
,
Christophe Courtieu
3   Service de Gynécologie-Obstétrique, CHU NTmes
,
Christine Biron
4   Laboratoire d’Hématologie, CHU, Montpellier
,
Méderic Hoffet
3   Service de Gynécologie-Obstétrique, CHU NTmes
,
Bernard Hédon
5   Service de Gynécologie-Obstétrique, CHU, Montpellier, France
,
Pierre Marés
2   Laboratoire d’Hématologie, Faculté de Pharmacie, Montpellier
› Author Affiliations
Further Information

Publication History

Received 09 August 1996

Accepted after revision 06 March 1997

Publication Date:
12 July 2018 (online)

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Summary

The prevalence of haemostasis abnormalities was evaluated in 500 consecutive women with unexplained primary recurrent miscarriages. Two matched reference groups with no antecedent of miscarriage were studied: 100 healthy mothers and 50 childless women.

In the prospective part of the study, we found 9.4% of the patients (95% C.I.: 6.8-12%) with an isolated factor XII deficiency, 7.4% of the patients (5.0-9.8%) with primary antiphopholipid antibodies, 47% of the patients (42.6-51.4%) with an insufficient response to the venous occlusion test and an isolated hypofibri- nolysis was found in 42.6% (38.2-47%) of the patients (reference groups: respectively 0/150, 3/150, 2/150, 2/150, pclO’3). Willebrand disease, fibrinogen deficiency, antithrombin, protein C or protein S deficiencies were not more frequent in recurrent aborters than in members of the reference groups. In the retrospective part of the study, cases of plasma resistance to activated protein C were not abnormally frequent.

Patients had higher Willebrand factor antigen (vWF), tissue-type plasminogen activator antigen (t-PA), plasminogen activator inhibitor activity (PAI) and D-dimers (D-Di) than the reference women. Values of vWF, t-PA, PAI and D-Di were altogether correlated but were not related to C-reactive protein concentrations. Among patients, those with an antiphospholipid syndrome and those with an insufficient response to the venous occlusion test had higher vWF, t-PA, PAI and D-Di values than the patients with none of the haemostasis-related abnormalities.

Thus, factor XII deficiency and hypofibrinolysis (mainly high PAI) are the most frequent haemostasis-related abnormalities found in unexplained primary recurrent aborters. In patients with antiphospholipid antibodies or hypofibrinolysis, there is a non-inflammatory ongoing chronic elevation of markers of endothelial stimulation associated with coagulation activation. This should allow to define subgroups of patients for future therapeutic trials.

 

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