Bombeli T, Raddatz-Mueller P, Fehr J
Coagulation Laboratory, Division of Haematology, Department of Internal Medicine, University Hospital of Zurich, Switzerland.
Am J Obstet Gynecol. 2001 Feb;184(3):382-9. doi: 10.1067/mob.2001.109397.
Because coagulation activation markers have been shown to indicate an increased risk of thrombosis, we tested whether thrombin-antithrombin III complexes and D-dimers correlated with the risk assessment in pregnant women on the basis of clinical data.
We divided a group of 261 pregnant women (305 pregnancies) into low- and high-risk groups according to the personal and family histories of thrombosis and the presence of a hereditary or an acquired thrombophilia. Women with a thrombotic event in the current pregnancy formed a separate group. All pregnancies with or without heparin therapy were closely monitored with thrombin-antithrombin III and D-dimer values for the entire course of the pregnancy. Retrospectively, the data were then correlated with the different groups and subgroups.
The course of the mean thrombin-antithrombin III values of all 305 pregnancies was close to or slightly above the upper cutoff line, whereas the D-dimer values were well within the normal range. Independent of heparin, there was no difference in the course of the thrombin-antithrombin III and D-dimer values between the low- and high-risk groups. Only women with ongoing thrombosis during pregnancy had significantly higher thrombin-antithrombin III and D-dimer values with or without heparin therapy. Among those individuals with elevated thrombin-antithrombin III or D-dimer values, there were no specific, recognizable patients who had elevated markers more often than others.
Thrombin-antithrombin III and D-dimer values do not correlate with a risk stratification assessed by clinical criteria. There are many women at low clinical risk who have elevated markers, and there are many women at very high clinical risk who have normal markers. Thus thromboprophylaxis would often be used inadequately if the indication were based on coagulation markers.
由于凝血激活标志物已被证明可提示血栓形成风险增加，我们基于临床数据测试了凝血酶 - 抗凝血酶III复合物和D - 二聚体是否与孕妇的风险评估相关。
我们根据血栓形成的个人和家族病史以及遗传性或获得性血栓形成倾向的存在，将一组261名孕妇（305次妊娠）分为低风险组和高风险组。当前妊娠中有血栓形成事件的女性组成一个单独的组。所有接受或未接受肝素治疗的妊娠在整个孕期都密切监测凝血酶 - 抗凝血酶III和D - 二聚体值。然后回顾性地将数据与不同的组和亚组进行关联。
所有305次妊娠的平均凝血酶 - 抗凝血酶III值的变化过程接近或略高于上限，而D - 二聚体值则完全在正常范围内。与肝素无关，低风险组和高风险组之间凝血酶 - 抗凝血酶III和D - 二聚体值的变化过程没有差异。只有孕期持续发生血栓形成的女性，无论是否接受肝素治疗，其凝血酶 - 抗凝血酶III和D - 二聚体值均显著升高。在凝血酶 - 抗凝血酶III或D - 二聚体值升高的个体中，没有特定的、可识别的患者其标志物升高的频率高于其他人。
凝血酶 - 抗凝血酶III和D - 二聚体值与临床标准评估的风险分层无关。有许多临床风险低的女性标志物升高，也有许多临床风险非常高的女性标志物正常。因此，如果基于凝血标志物进行预防，血栓预防措施往往会使用不当。
