62 - Oral Communication
Pediatrics & Gynecology-Obstetrics
Feb. 25, 2021, 1:45 p.m. - 3:15 p.m., Barcelona
Differences in the coagulation profile in women with mild and severe eclampsia
E. Lefkou1, 2, A. Rousseau3, P. Vandreden3, 2, L. Papageorgiou2, G. Gerotziafas2, Presenter: G. Gerotziafas2 (1Thessaloniki, 2Paris, 3Gennevilliers)
Background and Objective
Coagulation abnormalities have been reported in early onset preeclampsia (EOP). However, their association with disease severity is yet unclear. To address this question, we assessed biomarkers of hypercoagulability in women with mild and severe preeclampsia.
This is an observational retrospective case–control study. Plasma samples were collected from 84 women divided into three groups: healthy pregnant (HP; n=35), mild preeclampsia (MP; n=34) and severe preeclampsia (SP; n=15). The study population general characteristics are shown in Table 1. The following biomarkers were assessed: Tissue factor activity (TFa), Procoagulant phospholipid activity (PPL), Protein S, D-Dimers, Antithrombin (AT), thrombomodulin, TFPI levels, aPTT , PT and fibrinogen
TFPI, TFa and TMa levels significantly increased in MP and SP as compared to HP. No significant difference of TFPI, TFa was observed between MP and SP. TMa levels were significantly increased in SP as compared to MP. TFa/TFPI ratio was also lower in SP as compared to MP. Women in MP or SP had similarly shorter PPL as compared to HP. D-Dimer levels were significantly higher in SP as compared to MP. The levels of free PS activity in MP was significantly lower than that of the HP or SP. Fibrinogen levels were not significantly different in the three studied groups. PT was increased in MP and SP compared to the HP. The mean PT was found to increase with increasing severity of disease (p<0.001). The aPTT was increased along with increasing disease severity (p<0.001). The AT levels decreased in severe SP and MP or compared to HP (76.33±4.32 and 88.06±9.68 versus 95.40±0.36 respectively; p<0.001). This decrease was more pronounced in SP compared to MP (p<0.001).
Preeclampsia is associated with endothelial cell activation as documented by the increase of TFa, soluble TM levels and TFPI levels in plasma. Release of soluble TM and TFPI rather than TFa by endothelial cells appear to be related with the degree of preeclampsia severity. Women with preeclampsia showed marked decrease of PPL clotting time indicating enhanced platelet activation. In contrast, women with SP showed signs of enhanced hypercoagulability documented by the increase of D-dimer levels consumption of natural coagulation inhibitors and particularly of AT. This phenomenon tended to be reflected on the prolongation of PT and aPTT in severe preeclampsia.