Effect of blood loss during caesarean section on coagulation parameters
| Autor: | E. Stickeler, V.E. Tchaikovski, S. N. Tchaikovski, Tilman M. Hackeng, M. C. L. G. D. Thomassen, SD Costa, A. Wasserloos, Ana Claudia Zenclussen |
|---|---|
| Přispěvatelé: | Biochemie, RS: Carim - B03 Cell biochemistry of thrombosis and haemostasis, RS: Carim - B01 Blood proteins & engineering |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_treatment
PROTEIN-S DETERMINANTS 030204 cardiovascular system & hematology FACTOR PATHWAY INHIBITOR Protein S 03 medical and health sciences 0302 clinical medicine Blood loss Pregnancy Germany medicine Humans Caesarean section Prospective Studies THROMBIN GENERATION Prospective cohort study Blood Coagulation Activated Protein C Resistance VENOUS THROMBOEMBOLISM Coagulation biology PLASMA business.industry Cesarean Section Hematology medicine.disease Venous thrombosis TISSUE FACTOR 030220 oncology & carcinogenesis Anesthesia biology.protein RISK-FACTORS Female business Protein C Thrombotic complication SYSTEM medicine.drug |
| Zdroj: | Thrombosis Research, 202, 84-89. Elsevier Science |
| ISSN: | 1879-2472 0049-3848 |
| Popis: | Introduction: Venous thrombosis is the leading cause of pregnancy-related maternal morbidity and mortality. The thrombosis risk is increased by caesarean section and blood loss, though underlying mechanisms of these prothrombotic changes remain unknown.Materials and methods: This prospective study recruited 50 pregnant women at term undergoing elective caesarean section at University Hospital Magdeburg, Germany. Blood loss during surgery was correlated with the changes in total protein S, full length TFPI (TFPIfl), prothrombin, the endogenous thrombin potential (ETP) and resistance to activated protein C (APCsr) determined via calibrated automated thrombography.Results: Mean blood loss was 506 ml (95%CI: 456 to 557 ml). Total protein S was 0.63 (95%CI: 0.60 to 0.67) U/ ml preoperatively, decreased by 14.8% after caesarean section and almost normalised five days later. TFPIfl was 0.47 (95%CI: 0.41 to 0.53) U/ml before, remained unchanged immediately after and increased by 11.5% five days after surgery. Prothormbin was 1.10 (95%CI: 1.03 to 1.16) U/ml preoperatively, reduced by 10.4% immediately after and increased again five days after caesarean section, exceeding the preoperative values by 4.4% (-0.7 to 9.6). The ETP decreased by 3.9%, whereas the APCsr increased by 37.0% immediately after caesarean section. The changes in total protein S, prothrombin, thrombin generation and APC resistance showed a trend to be more pronounced in the subgroups with higher blood loss.Discussion: Moderate blood loss during caesarean section hardly reduces thrombin generation but aggravates pregnancy-induced APC resistance and combined deficiency of TFPI and protein S, which can account for the increased thrombosis risk in early puerperium. |
| Databáze: | OpenAIRE |
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