thromboplastin and Postpartum-Hemorrhage

Recombinant activated factor VIIa (rFVIIa) has many clinical applications for patients with congenital bleeding disorders and in a variety of clinical settings. Additional studies in the future are ongoing and should provide the clinical anesthesiologist an additional option during certain bleeding states. Specific recommendations as to timing of administration and frequent monitoring of ionized calcium status are suggested at this time. Optimization of fibrinogen levels, platelet levels, pH, and body temperature will enhance efficacy of rFVIIa.

Topics: Cerebral Hemorrhage; Factor VIIa; Hemophilia A; Hemophilia B; Humans; Postpartum Hemorrhage; Recombinant Proteins; Thromboplastin; Warfare; Wounds and Injuries

As activation of the coagulation pathway is a physiological response to injury, the development of disseminated intravascular coagulation (DIC) is a warning signal to the clinician that the primary pathological disease state is decompensating. In pregnancy, DIC can occur in several settings, which include emergencies such as placental abruption and amniotic fluid embolism as well as complications such as pre-eclampsia. Whilst the acuteness of the event and the proportionality in the coagulant and fibrinolytic responses may vary between these different conditions, a common theme for pregnancy-associated DIC is the pivotal role played by the placenta. Removal of the placenta is the linchpin to treatment in most cases but appropriate blood product support is also key to management. This is necessary because DIC itself can have pathological consequences that translate clinically into a worse prognosis for affected patients. This article will describe how pregnancy-associated DIC can be diagnosed promptly and how treatment should be managed strategically. It also discusses the latest developments in our understanding of haemostatic mechanisms within the placenta and how these may have relevance to new diagnostic approaches as well as novel therapeutic modalities.

Topics: Anticoagulants; Blood Coagulation Factors; Blood Component Transfusion; Disseminated Intravascular Coagulation; Factor VIIa; Female; Humans; Obstetric Labor Complications; Placenta; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Hematologic; Thromboplastin

Tissue factor (TF) is best known as the primary cellular initiator of blood coagulation. After vessel injury, the TF:FVIIa complex activates the coagulation protease cascade, which leads to fibrin deposition and activation of platelets. TF deficiency causes embryonic lethality in the mouse and there have been no reports of TF deficiency in humans. These results indicate that TF is essential for life, most likely because of its central role in hemostasis. In addition, aberrant TF expression within the vasculature initiates life-threatening thrombosis in various diseases, such as sepsis, atherosclerosis, and cancer. Finally, recent studies have revealed a nonhemostatic role of TF in the generation of coagulation proteases and subsequent activation of protease activated receptors (PARs) on vascular cells. This TF-dependent signaling contributes to a variety of biological processes, including inflammation, angiogenesis, metastasis, and cell migration. This review focuses on the roles of TF in hemostasis, thrombosis, and vascular development.

Topics: Animals; Blood Coagulation Factors; Blood Vessels; Coronary Vessels; Female; Fetal Death; Hemorrhage; Hemostasis; Humans; Mice; Mice, Knockout; Myocytes, Cardiac; Phenotype; Placenta; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Hematologic; Thromboplastin; Thrombosis; Uterus; Yolk Sac

Topics: Abortion, Induced; Abruptio Placentae; Afibrinogenemia; Amniotic Fluid; Anticoagulants; Blood Coagulation Disorders; Embolism; Embolism, Amniotic Fluid; Female; Fetal Death; Fibrinolysis; History; Humans; Obstetrics; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Thromboplastin

Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. Promptly recovering blood loss is critical for PPH. Intraoperative cell salvage (ICS) is a method to collect and process red blood cells (RBCs) from the blood lost during surgery and transfuse them to the patient's circulation during or immediately after surgery. Its effectiveness in reducing the demand for allogeneic blood transfusion has been proven, but its effectiveness and safety as a sole treatment for PPH during Cesarean sections are unclear. This is particularly important for patients who cannot or do not want to accept allogeneic blood transfusion.. In this prospective randomized controlled study, patients with high risks of PPH were randomized into the ICS group or the control group, receiving ICS or allogeneic RBC transfusion if their hemoglobin level was less than 80 g/L during operation. Data collected include clinical examination, blood cell count, hemoglobin level, coagulation function, and plasma levels of fetal hemoglobin, tissue factor, and alpha-fetoprotein before and after fetal delivery and 0, 2, and 12 h after treatment. Adverse events were recorded.. A total of 130 patients were enrolled, aged 33 ± 1 years with a mean gestation period of 37 ± 1 week. The most common cause of Cesarean section was placenta previa, followed by twin pregnancy, scarred uterus, preeclampsia, placental abruption, fetal distress, and placenta accreta spectrum. Bleeding amount was similar between the two groups. The ICS group, compared to controls, had more efficient increases in levels of hemoglobin, RBC, and hematocrit (all p < 0.05). Coagulation function was maintained in the ICS group but reduced in controls 24 h after transfusion, indicated by significantly reduced fibrinogen level and prolonged prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (aPTT) (all p < 0.05). There was a transient but significant decrease in plasma tissue factor and alpha-fetoprotein levels and an increase in plasma fetal hemoglobin level with ICS treatment in the postpartum period. No adverse event occurred with ICS intervention.. ICS is an effective and safe intervention for patients with a high risk of PPH during elective or emergency Cesarean section. It can effectively clear tissue factors and alpha-fetoprotein but not fetal hemoglobin.

Topics: alpha-Fetoproteins; Cesarean Section; Female; Fibrinogen; Hemoglobins; Humans; Placenta; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Thromboplastin

Postpartum hemorrhage is a leading cause of morbidity and mortality worldwide, yet the associated early coagulopathy is not well defined.. We hypothesized that women who develop postpartum hemorrhage have a distinct derangement of thrombin generation and coagulation factors compared with postpartum women without postpartum hemorrhage.. This prospective study of pregnant patients with postpartum hemorrhage was completed at a single urban hospital. Blood was drawn on postpartum hemorrhage diagnosis and 2 and 4 hours later. Assays of patients with postpartum hemorrhage included thrombelastography, whole blood thrombin generation, coagulation factor activity, tissue factor levels and activity, and tissue factor pathway inhibitor levels, which were compared with that of patients without postpartum hemorrhage.. A total of 81 patients were included in this study. Of those patients, 66 had postpartum hemorrhage, and 15 served as controls. Compared with patients without PPH, patients with postpartum hemorrhage had lower fibrinogen levels (469.0 mg/dL vs 411.0 mg/dL; P=.02), increased tissue plasminogen activator resistance (fibrinolysis 30 minutes after maximal clot strength: 8.7% vs 4.2%; P=.02), decreased peak thrombin concentration (150.2 nM vs 40.7 nM; P=.01), and decreased maximal rate of thrombin generation (60.1 nM/minute vs 2.8 nM/minute; P=.02). Furthermore, compared with patients without postpartum hemorrhage, patients with postpartum hemorrhage had decreased tissue factor levels (444.3 pg/mL vs 267.1 pg/mL; P=.02) and increased tissue factor pathway inhibitor levels (0.6 U/mL vs 0.8 U/mL; P=.04), with decreased tissue factor pathway inhibitor ratios (624 vs 299; P=.01).. PPH is not only an issue of uterine tone and mechanical bleeding but also a distinct coagulopathy that is characterized by decreased fibrinogen level, clot breakdown resistance, and markedly low thrombin generation. This pathology seemed to be driven by low tissue factor and high tissue factor pathway inhibitor levels.

Topics: Female; Fibrinogen; Humans; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Thrombin; Thromboplastin; Tissue Plasminogen Activator; Uterine Inertia

Severe postpartum hemorrhage (PPH), defined as a blood loss ≥1000 mL, is associated with maternal morbidity and mortality.. We aimed at characterizing coagulation properties of predelivery plasmas from pregnant women with thrombin generation assay and hemostatic biomarkers (plasminogen activator inhibitor-1, tissue factor [TF], and thrombomodulin).. A nested case-control study was conducted within the "Study of Biological Determinants of Bleeding Postpartum," a French prospective cohort study, in order to compare women with severe PPH (cases) and controls matched for age, body mass index, term, and mode of delivery. Plasma was collected at entry in the delivery room, and blood loss was measured objectively. The predelivery endogenous thrombin generation potential (ETP) was measured in plasma using calibrated automated thrombinography and low TF concentration. Hemostatic biomarkers were measured using ELISA kits.. A total of 142 women (71 cases and 71 controls) were investigated. There was no difference in the median lag phase, thrombin peak, and time to peak between cases and controls. However, median predelivery ETP was lower in cases than in controls (2170 vs 2408 nM.min, P < .0001), independently of mode of delivery and PPH etiology. Median plasminogen activator inhibitor-1 and TF levels were higher in cases compared with controls (107.4 vs 68.1 ng/mL, P = .0003; 34.4 vs 27.4 pg/mL, P = .007), whereas thrombomodulin levels did not differ between the 2 groups.. Among thrombin generation assay parameters, predelivery ETP levels may have a predictive value for severe PPH.

Topics: Biomarkers; Blood Coagulation Tests; Case-Control Studies; Female; Hemostatics; Humans; Male; Plasminogen Inactivators; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Prospective Studies; Thrombin; Thrombomodulin; Thromboplastin

Topics: Adult; Aprotinin; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Hemostasis; Humans; In Vitro Techniques; Placental Extracts; Postpartum Hemorrhage; Pregnancy; Thromboplastin

Topics: Abruptio Placentae; Afibrinogenemia; Blood Coagulation Disorders; Embolism, Amniotic Fluid; Female; Humans; Obstetric Labor Complications; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Shock; Thromboplastin; Tissue Extracts

Topics: Blood Coagulation; Female; Fibrinolysis; Hemostasis; Humans; Labor, Obstetric; Menorrhagia; Menstruation; Postpartum Hemorrhage; Pregnancy; Thromboplastin

Topics: Afibrinogenemia; Female; Fibrin; Hemorrhage; Humans; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Complications; Thromboplastin