Coagulation assessment by rotation thrombelastometry in normal pregnancy

Cyril Huissoud; Nicolas Carrabin; Mehdi Benchaib; Oriane Fontaine; Albrice Levrat; Denis Massignon; Sandrine Touzet; René-Charles Rudigoz; Michel Berland

doi:10.1160/TH08-06-0386

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 101(04): 755-761
DOI: 10.1160/TH08-06-0386

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Coagulation assessment by rotation thrombelastometry in normal pregnancy

Cyril Huissoud

¹Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France

²INSERM U846, Stem Cell and Brain Research Institute, Bron, Université de Lyon 1, UMR-S 846, Lyon, France

,

Nicolas Carrabin

¹Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France

,

Mehdi Benchaib

³Human Assisted Reproduction Laboratory, Hôpital Femme-Mère-Enfant, Bron Cedex, France

⁴Claude Bernard University, University of Lyon, University Lyon 1, France

,

Oriane Fontaine

⁵Intensive Care and EMS, Edouard Herriot University Hospital, Hospices civils de Lyon, Lyon, France

,

Albrice Levrat

⁵Intensive Care and EMS, Edouard Herriot University Hospital, Hospices civils de Lyon, Lyon, France

,

Denis Massignon

⁶Haemostasis Laboratory, University Hospital Lyon-Sud, Hospices civils de Lyon, France

,

Sandrine Touzet

⁴Claude Bernard University, University of Lyon, University Lyon 1, France

⁶Haemostasis Laboratory, University Hospital Lyon-Sud, Hospices civils de Lyon, France

⁷Epidemiology, Professional Practices and Healthcare Networks Study Unit, Hospices Civils de Lyon, Pole IMER, Lyon, France

,

René-Charles Rudigoz

¹Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France

⁴Claude Bernard University, University of Lyon, University Lyon 1, France

,

Michel Berland

⁴Claude Bernard University, University of Lyon, University Lyon 1, France

⁸Department of Obstetrics and Gynecology, University Hospital Lyon-Sud, Hospices civils de Lyon, France

› Author Affiliations

Abstract

Summary

We analysed changes in coagulation during normal pregnancy with a novel point-of-care device based on thrombelastometry (ROTEM^®). We compared the results obtained with those of standard coagulation tests in 104 patients: 20 non-pregnant women (controls) and 84 women in the first (T1, n=17), second (T2, n=9) and third (T3, n=58) trimesters of pregnancy. We measured the clotting time (CT), the maximum clot firmness (MCF), the early clot amplitude at 5 and 15 minutes (CA5, CA15) and the clot lysis index (CLI30) with four tests containing specific reagents. (a) The INTEM^® test involving ellagic acid activated the intrinsic pathway and (b) the EXTEM^® test using tissue factor triggered the extrinsic pathway; (c) The FIBTEM^® test based on a platelet inhibitor (cytochalasin D) evaluated the contribution of fibrinogen to clot formation and (d) the APTEM^® test was similar to the EXTEM but was based on inhibition in vitro of fibrinolysis by aprotinin. CT and CLI30 were not significantly modified during pregnancy whereas MCF, CA5 and CA15 (INTEM, EXTEM, FIBTEM) increased significantly between the second and third trimesters (e.g. median [interquartile range]: MCF-FIBTEM, 13 [11–16] mm vs. 19 [17–23] mm, respectively, in controls and T3, p< 0.001). EXTEM values were not significantly different from those measured with APTEM. There were significant correlations between the results obtained with ROTEM and those from standard coagulation tests. ROTEM analysis showed a marked increase in coagulability during normal pregnancy. ROTEM values may serve as the basis for future studies in pregnant women.

Keywords

Thrombelastometry - thrombelastography - pregnancy - hyper-coagulability

Full Text

References

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