Abstract
BackgroundIt is well accepted that the gravid state is hypercoagulable and a significant cause of both maternal morbidity and mortality in the Western world. Although thrombin generation is reported to be increased in pregnant women, uncertainty exists on the pattern of thrombin generation change during this time. The aim of this study is to describe thrombin generation changes and D-dimer concentrations in women injecting enoxaparin during pregnancy the postnatal period.MethodsOne hundred and twenty-three women injecting enoxaparin had their thrombin generation, as measured by Calibrated Automated Thombinography (CAT), repeatedly assayed during pregnancy, once in each trimester, at delivery and 8 weeks post-partum. Furthermore, to understand the impact enoxaparin has on D-dimer concentrations during pregnancy, D-dimer concentrations were measured monthly in the recruited women.ResultsThrombin generation was found to increase in the first trimester (mean endogenous thrombin potential (ETP): 1391 nmol/L.min), further increasing during the second trimester (mean ETP: 1757 nmol/L.min), after which it plateaued through to delivery, where it peaked (mean ETP: 1857 nmol/L.min) and then fell back at 8 weeks post-partum (ETP: 1293 nmol/L.min). In contrast D-dimer concentrations increased exponentially during the antenatal period, despite the enoxaparin prescription.ConclusionOur results provide further evidence on alterations of thrombin generation during pregnancy and the postnatal period.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0384-0) contains supplementary material, which is available to authorized users.
Highlights
It is well accepted that the gravid state is hypercoagulable and a significant cause of both maternal morbidity and mortality in the Western world
Details on the 19 women prescribed treatment doses of enoxaparin (9 women managed for antenatal VTE and the 10 women switched from long-term warfarin during pregnancy) are presented in Additional file 2: Table S2 and Additional file 3: TableS3 respectively
With the 8 weeks post-partum sample acting as a baseline measurement for the recruited women, we found a rise in thrombin generation had already occurred in the first trimester, with a further rise during the second trimester, after which a thrombin generation plateau was reached through to delivery
Summary
It is well accepted that the gravid state is hypercoagulable and a significant cause of both maternal morbidity and mortality in the Western world. The aim of this study is to describe thrombin generation changes and D-dimer concentrations in women injecting enoxaparin during pregnancy the postnatal period. Global coagulation assays, such as the thrombin generation assay, explore the initiation, propagation and termination phases of coagulation [1], and so can detect an underlying prothrombotic state. Studies have demonstrated the utility of the thrombin generation assay in identifying the prothrombotic states seen with increasing age [2], in the obese [3], those with thrombophilia [4], users of oral contraception and hormone replacement. The aim of this study was to investigate how thrombin generation and D-dimer concentrations were altered in pregnant women injecting enoxaparin during pregnancy and the postnatal period Some studies have demonstrated this to be the case when pregnant women concurrently inject prophylactic doses of LMWH [19,20].
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