Seidel Holger, Duncklenberg Melina, Hertfelder Hans-Jörg, Gnida Christine, Westhofen Philipp, Stremlau Anna, Feriel Joffrey, Depasse François, McRae Hannah L, Kruppenbacher Johannes Philipp
Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Bonn, Germany.
Clinical Development, Diagnostica Stago, Asnières sur Seine, France.
TH Open. 2024 Jul 11;8(3):e283-e296. doi: 10.1055/s-0044-1788281. eCollection 2024 Jul.
During pregnancy, a physiological increase of molecular activation markers (MAM) of hemostasis such as prothrombin fragments 1 + 2, thrombin-antithrombin complex, and D-dimers (DD) occurs. Therefore, monitoring MAM levels during pregnancy to evaluate the risk of venous thromboembolism (VTE) may be unreliable; nevertheless, DD analysis in pregnancy is widely performed. In contrast to DD, fibrin monomer (FM) levels have been reported to remain stable during pregnancy. The main aim of this study was to define the expected range for FM levels in pregnant outpatients. In addition, we examined the impact of the individual VTE risk, as calculated by the pregnancy risk score of the Royal College of Obstetricians and Gynaecologists (RCOG), as well as that of antithrombotic treatment on FM levels. A total of 342 pregnant women seen at our hemostasis unit were included throughout 350 pregnancies in 899 samples. Low-risk thrombophilia, but not the RCOG score itself, was found to influence all MAM levels, whereas antithrombotic treatment had only an impact on DD. For FM, a reference range could be calculated irrespective of the pregnancy term, in contrast to other MAMs, which fluctuated throughout pregnancy. Our findings suggest a stronger impact of inherited thrombophilia on hemostasis activity during pregnancy as compared with acquired or other predisposing thrombophilic risk factors. FM levels showed a marginal increase during pregnancy in contrast to other MAM and remain a potential candidate to improve the laboratory assessment of VTE risk during pregnancy. Further prospective studies in pregnant patients with suspicion of VTE are needed.
在怀孕期间，凝血分子激活标志物（MAM）会出现生理性增加，如凝血酶原片段1+2、凝血酶 - 抗凝血酶复合物和D - 二聚体（DD）。因此，在孕期监测MAM水平以评估静脉血栓栓塞（VTE）风险可能并不可靠；尽管如此，孕期DD分析仍被广泛开展。与DD不同，有报道称纤维蛋白单体（FM）水平在孕期保持稳定。
本研究的主要目的是确定门诊孕妇FM水平的预期范围。此外，我们还研究了根据皇家妇产科医师学院（RCOG）的妊娠风险评分计算出的个体VTE风险以及抗血栓治疗对FM水平的影响。
我们的止血科共纳入了342名孕妇，涉及899份样本中的350次妊娠。
研究发现，低风险血栓形成倾向而非RCOG评分本身会影响所有MAM水平，而抗血栓治疗仅对DD有影响。与其他在孕期波动的MAM不同，FM的参考范围可在不考虑孕周的情况下计算得出。
我们的研究结果表明，与获得性或其他易患血栓形成倾向风险因素相比，遗传性血栓形成倾向对孕期止血活性的影响更大。与其他MAM相比，FM水平在孕期仅略有升高，仍是改善孕期VTE风险实验室评估的潜在指标。需要对疑似VTE的孕妇进行进一步的前瞻性研究。
