Thromboelastometry as an adjunctive test in thrombophilia screening for adverse pregnancy outcome

Abstract

ING FOR ADVERSE PREGNANCY OUTCOME LEONIE FLACH, JORIS LENGLET, HERMAN VAN GEIJN, ANTOINETTE BOLTE, VU University Medical Center, Obstetrics & Gynecology, Amsterdam, Netherlands OBJECTIVE: Thrombophilia has been associated with adverse pregnancy outcome. Thromboelastometry is an easy, rapid and reproducible test that offers the opportunity to investigate all phases of coagulation and fibrinolysis in whole blood. The purpose of this study was to determine if an additional group of women with coagulopathy could be found with the use of thromboelastometry, that are not yet identified with routine thrombophilia screening and that are at risk of adverse pregnancy outcome. STUDY DESIGN: Included were women that had been referred for routine thrombophilia screening because of their complicated obstetric histories. The routine thrombophilia screening includes testing for protein S, protein C, antitrombin III, APC resistance, factor V Leiden, prothrombin mutation, antiphospholipid antibodies and methionine loading testing. Thromboelastometry was performed with ROTEM Gamma (Pentapharm GMBH, Munchen, Deutschland). Studied are the kinetics of clot formation, clotting time, clot formation time and the maximum clot firmness. RESULTS: 46 non-pregnant women with a history of previous severe preeclampsia, HELLP syndrome, IUGR, placental abruption, fetal loss and recurrent miscarriage were included. In 16 women thrombophilia was diagnosed by routine testing, in this group 5 women also had abnormal thromboelastometry. In 30 women no trombophilia was found, in this group 10 women had an abnormal tromboelastometry. Thromboelastometry identified only 31% of women with an abnormal thrombophilia screening. However, in 33% of the women with normal thrombophilia screening an abnormal thromboelastometry was found. CONCLUSION: Thromboelastrometry does detect a group of women with abnormal coagulation that are not detected by routine thrombophilia screening. Additional studies are warranted to determine if thromboelastometry identifies a subset of women with a prothrombotic tendency that are at an increased risk of recurrent adverse pregnancy outcome.