Effect of pregnancy on the relationship between concentration and anticoagulant action of heparin.

The anticoagulant effect of heparin, as reflected by the slope of the relationship between heparin concentration and the logarithm of the activated partial thromboplastin time (APTT), was determined in citrated plasma of seven women in the third trimester of pregnancy and in 10 nonpregnant women of comparable age. Factors II, V, and VII to XII, albumin, individual globulins, antithrombin III, fibrinogen, alpha-1-acid glycoprotein, alpha-1-antitrypsin, alpha-2-macroglobulin, prothrombin time, and hematocrit were also determined. Baseline APTT (i.e., APTT without heparin) was 30.2 +/- 3.0 sec (mean +/- SD) in the pregnant women and 29.6 +/- 4.7 sec in the controls (NS). The heparin slope value was 1.68 +/- 0.46 ml/U in the pregnant women and 2.33 +/- 0.49 ml/U in the controls, showing that the anticoagulant effect of heparin is decreased in pregnancy. The prothrombin time was also decreased in pregnancy (19.1 +/- 0.8 vs 23.1 +/- 0.5 sec; P less than 0.01). Pregnancy was associated with a significant increase in the activity of factors VII, VIII, IX, and X and in the concentrations of fibrinogen, alpha-1-globulin, and alpha-1-antitrypsin. The plasma albumin concentration was decreased in the pregnant group. In both the pregnant and nonpregnant women (considered separately), the heparin slope value correlated negatively with factor XI activity (r = -0.85 and -0.71; P less than 0.05). Baseline APTT, which was consistently found to correlate with heparin slope value in previous reports on men and nonpregnant women, also showed such correlation in the nonpregnant group of the present study (r = 0.85; P less than 0.05) but not in the group of pregnant women (r = -0.54; NS). The relative heparin resistance in pregnancy in this investigation is consistent with clinical reports of increased heparin requirements during pregnancy.