The Role of Fibrinolytic and Antifibrinolytic Activities in the Pathophysiology of HELLP Syndrome

Abstract

Objective. To determine the role of the fibrinolytic and antifibrinolytic systems in HELLP syndrome. Methods. This study consisted of patients with HELLP Syndrome (study group, n = 17), women who were admitted for routine prenatal care (pregnant control group, n = 21) and those presenting for routine gynecologic examination (non-pregnant control group, n = 21). Plasma tissue-type plasminogen activator (tPA), thrombin-activatable fibrinolysis inhibitor (TAFI), plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT) and thrombomodulin (TM) were measured at admission for all groups. They were again measured after 7 days of biochemical improvement in HELLP Syndrome group. Results. The mean ages of women in the study, pregnant, and non-pregnant control groups were 29.82 ± 4.98, 29.71 ± 5.64, and 27.60 ± 4.21, respectively. Demographically, the patients in all three groups were similar with regard to maternal age, race, and body mass index. Compared to the control groups, the mean tPA, PAI-1, TAFI, TAT, and TM levels were significantly increased in HELLP Syndrome. The mean plasma TAFI antigen concentration 7 days after delivery was significantly lower compared to the baseline (5.84 ± 7.14 % change, p < 0.01). Significant decreases in the mean plasma concentrations were also found in tPA (21.78 ± 20.93 ng/mL mean difference, p < 0.01), PAI-1 (14.22 ± 10.38 ng/mL mean difference, p < 0.001), TAT (0.93 ± 1.19 ng/mL mean difference, p < 0.01), and TM (0.54 ± 0.94 ng/mL mean difference, p < 0.05). Conclusion. It is likely that the impaired fibrinolytic and antifibrinolytic systems, in response to thrombus formation, affect the pathophysiology of HELLP syndrome.