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Thrombin potential and traditional coagulation assay: are they useful in exploring recurrent pregnancy loss risk?

In this study, we used the global coagulation assay, calibrated automated thrombography and traditional coagulation assay to search for a possible underlying hypercoagulable status in women with history of RPL compared with uneventful pregnancy women. Thrombin generation, Fibrinogen, factor VIII (FVIII), Plasminogen Activator Inhibitor-1 (PAI-1) and von Willebrand factor levels were analyzed in 92 not pregnant unexplained RPL and 64 uneventful pregnancy women. In RPL women, significantly higher fibrinogen, FVIII and PAI-1 levels, and thrombin generation with respect to those observed in uneventful pregnancy women were found. By dividing the study population into quartiles of endogenous thrombin potential (ETP), a lower percentage of RPL women than uneventful pregnancy women in the second quartile was observed, whereas a higher percentage of RPL in comparison with uneventful pregnancy women in the third and fourth quartile was found (P = 0.009). Accordingly, the cut-off ETP of 1222.1 nmol/l was chosen; ETP above cut-off concentration was associated with more than two-fold increased risk of RPL (P = 0.008), also after adjustment for traditional risk factors (P = 0.009). We provided evidence of an underlying alteration of vascular network related to increased coagulation components, and fibrinolysis inhibitor levels in healthy women with history RPL; therefore, calibrated automated thrombography global assay and testing for FVIII and PAI-1 would be advisable in cli...
Source: Blood Coagulation and Fibrinolysis - Category: Hematology Tags: Original Articles Source Type: research

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Authors: Demers C, Derzko C, David M, Douglas J Abstract OBJECTIVE: The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. OPTIONS: Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. EVIDENCE: A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: meno...
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
ConclusionsConsidering the importance of a differential diagnosis of thrombotic microangiopathic disorders, congenital thrombotic thrombocytopenic purpura may mimic the signs and symptoms of pre-eclampsia/eclampsia, hemolysis with elevated liver enzymes and low platelet count syndrome, and atypical hemolytic-uremic syndrome. It should be considered in suspect cases in patients with an ADAMTS13 activity at 5% without ADAMTS13 antibodies.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
Acquired von Willebrand disease (AVWD) has been described among patients with myeloproliferative neoplasms (MPN). We aimed to investigate the course of AVWD throughout pregnancy among MPN patients in relation to patient management and outcomes.
Source: American Journal of Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Poster Session I Source Type: research
CONCLUSIONS: Our results demonstrate for the first time the expression of ADAMTS13 mRNA and protein in normal and abnormal placental tissues and its role in promoting angiogenesis and trophoblastic cell development. The findings support the potential role of the ADAMTS13-von Willebrand factor pathway in normal pregnancy and pathogenesis of preeclampsia. PMID: 28751574 [PubMed - indexed for MEDLINE]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - Category: Cardiology Authors: Tags: Arterioscler Thromb Vasc Biol Source Type: research
Source: British Journal of Haematology - Category: Hematology Authors: Tags: Correspondence Source Type: research
The risk of pregnancy loss in von Willebrand disease (VWD) has been inconsistently reported. Von Willebrand factor (VWF) is a known regulator of angiogenesis, so has the potential to affect placental function. We sought to determine the risk of pregnancy loss and placenta-mediated pregnancy complications in women with VWD, compared with women without VWD. Women with VWD followed in the Southern Alberta Rare Blood and Bleeding Disorders Clinic were invited to participate in a questionnaire (February–June 2014). The same questionnaire was sent to women without VWD identified in a low-risk obstetrical clinic in Calgary,...
Source: Blood Coagulation and Fibrinolysis - Category: Hematology Tags: Original Articles Source Type: research
Despite treatment, women with von Willebrand disease (VWD) have lower von Willebrand factor (VWF) levels and greater blood loss at delivery than controls. Current weight-based dosing does not account for the ~1.5-fold increase in blood volume in pregnancy.
Source: Thrombosis Research - Category: Hematology Authors: Tags: Full Length Article Source Type: research
Von Willebrand disease (vWD) is the most common inherited bleeding disorder. Its association with pregnancy is infrequent. Here we report three cases of vWD associated with pregnancy. The clinical features of this combination are very suggestive. However, difficulties are still encountered during the diagnosis process. The first case was diagnosed for the first time during the patient ’s second pregnancy despite several episodes of vaginal bleeding and suggestive clinical symptomatology. The second case was diagnosed during childhood and the patient was properly managed during this pregnancy.
Source: Transfusion and Apheresis Science - Category: Hematology Authors: Tags: Review Source Type: research
AbstractSTUDY QUESTIONDo extravillous trophoblasts (EVTs) invade non-arterial decidual vessels in healthy and pathological pregnancies?SUMMARY ANSWEROur results reveal that trophoblast invasion of venous and lymphatic vessels is a frequent event during the first trimester of pregnancy and is compromised in   recurrent spontaneous abortion (RSA). In addition, the present data suggest that EVTs populate regional lymph nodes during pregnancy.WHAT IS ALREADY KNOWNHuman trophoblasts remodel and invade decidual spiral arteries. In addition, a recent report demonstrates that trophoblasts contact and invade decidual veins.STU...
Source: Human Reproduction - Category: Reproduction Medicine Source Type: research
Authors: Singal M, Kouides PA Abstract von Willebrand disease (VWD) is caused by quantitative or qualitative defects in von Willebrand factor (VWF). The mainstay of therapy is desmopressin, which is, however, not useful in certain forms of VWD notwithstanding adverse events. For these patients, plasma-derived factor VIII (pdFVIII)/VWF concentrates have been available for close to three decades but have a theoretical risk of disease transmission, hypersensitivity/allergic reactions, inhibitors and thrombosis. A recombinant VWF (vonicog alfa, Vonvendi™; manufactured by Baxalta, now part of Shire) was approved b...
Source: Drugs of Today - Category: Drugs & Pharmacology Tags: Drugs Today (Barc) Source Type: research
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