The Predictive Value of the Hemostasis Parameters in the Development of Preeclampsia

1992 ◽  
Vol 67 (02) ◽  
pp. 214-218 ◽  
Author(s):  
Chao-Hung Ho ◽  
Zwa-Ling Yang
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Plasminogen Activator ◽  
Predictive Value ◽  
Antithrombin Iii ◽  
Serine Esterase ◽  
Plasminogen Activator Inhibitor 1 ◽  
Significant Difference ◽  
At Iii ◽  
D Dimer

SummaryIn order to find out which hemostasis parameters would have the predictive value for the development of preeclampsia, modified antithrombin III (ATM, representative of the antithrombin Ill-serine esterase complex), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), beta-throm-boglobulin (BTG), antithrombin III (AT III), fibrinogen, fibrin(ogen) degradation product (FDP), FDP D-dimer and euglobulin lysis time (ELT) were measured in 20 normal nonpregnant women, 21 normal pregnant women, 6 high-risk pregnant women, 14 preeclampsia pregnant women, and 5 patients with disseminated intravascular coagulation (DIC). Only tPA and AT III were found significantly different between the preeclampsia and the normal or high-risk pregnant women: tPA was found progressively and significantly increased from the normal pregnant, to the high-risk pregnant, then to the preeclampsia women (p <0.05). AT III was significantly lower in the preeclampsia than in the normal pregnant (p = 0.0001) or in the high-risk pregnant women (p = 0.002). In the 2nd trimester, tPA, PAI, fibrinogen and FDP were significantly higher, and AT III was significantly lower in the preeclampsia than in the normal pregnant women, whereas in the 3rd trimester, tPA and AT III were significantly higher or lower, respectively, in the preeclampsia than in the normal pregnant women. No significant difference of ATM could be found between the preeclampsia and the normal or high-risk pregnant women. From the present study, we suggest that tPA and AT III would be used as the main predictors, and FDP and D-dimer as the complementary predictors for the development of preeclampsia and should be detected in the normal or high-risk pregnant women.

Coagulation Markers Levels Measured during Acute Infection May Predict the Development of Long Term Cardio- and Cerebro-Vascular Events in Elderly.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3989-3989
Author(s):  
Asher Winder ◽  
Tatiana Bruzgol ◽  
Inna Lichman ◽  
Amir Herman ◽  
Eyal Leibovitz ◽  
...  
Keyword(s):  
High Risk ◽  
Statistical Significance ◽  
Acute Infection ◽  
Coagulation System ◽  
Plasminogen Activator Inhibitor 1 ◽  
Vascular Events ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
D Dimer

Abstract Introduction: The coagulation system plays a pivotal role in the creation and development of vascular clotting. It is activated during infection episodes, as can be measured by different markers like, d-dimer, plasminogen activator inhibitor-1 (PAI1) and fibrinogen. The goal of this study was to check whether high levels of d-dimer, fibrinogen or PAI1 during acute infection, as markers of the coagulation system, indicates higher risk for cerebro-cardiovascular disease or any cause mortality in elderly during 6 months after the infection episode. Methods: Coagulation markers, d-dimer, fibrinogen and PAI1 levels as well as other routine demographic and laboratory variables were recorded in elderly patients hospitalized due to infections. The variables were recorded at the time of admission, at discharge and at 6 months after discharge. End points of the study were Cerebro vascular events, acute coronary syndrome, other thromboembolic events and all cause mortality. Results: The study group consisted of 52 patients, 5 of them died during hospitalization, 4 died later from infectious complications and 6 had a cerebrovascular or cardiovascular (CCV) event. Lower fibrinogen levels were associated with development of CCV events. A statistically significant difference (p=0.048) was found between fibrinogen levels at time of discharge from the hospital among patients with CCV event (366±149 mg/dL) compared to the levels among patients without CCV event (511±139 mg/dL), though comparing fibrinogen levels at admission did not reach statistical significance (patients with CCV event −456±70 mg/dL, patients without CCV event −544±133 mg/dL, p=0.052). Furthermore, the ratio of d-dimer levels measured in admission to the levels at discharge was found to be significantly higher (p=0.029) in patients that eventually had CCV event (1.60±0.5) compared to patients who did not have CCV event (1.12±0.4). PAI-1, Platelets or other Blood variables were not significantly different between the groups. Based on these differences an algorithm was build to identify patients with infection in high risk for CCV event (figure). Patients with fibrinogen levels on admission below 530 mg/dL and d-dimer ratio above 1.54 were identified to be at high risk for CCV event. The algorithm yielded a sensitivity and specificity of 66% and 95%, respectively. The hazard ratio for these patients was found to be 16.8 (95% confidence interval: 3.06–92). Conclusions: In this study we found that lower levels of fibrinogen are associated with higher risk for developing a CCV event, while the opposite occurs for d-dimer ratio. An algorithm was developed for identification of high risk patients. Further research is needed to validate these results in order to identify a group of people that might benefit from long term antithrombotic agents in order to prevent cardio and cerebro-vascular events. Figure Figure

scholarly journals Effect of CMF-chemotherapy on blood coagulation in patients with breast cancer

2002 ◽  
Vol 10 (2) ◽  
pp. 61-66
Author(s):  
Dragana Petrovic
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Protein C ◽  
Antithrombin Iii ◽  
Metastatic Breast ◽  
Breast Cancer Patients ◽  
Significant Difference ◽  
At Iii ◽  
D Dimer

BACKGROUND: Influences of CMF (cyclophosphamide, methotrexate,5-fluorouracil) chemotherapy on blood coagulation were investigated in 30 patients receiving adjuvant chemotherapy and in 30 patients receiving chemotherapy for metastatic breast cancer. METHODS: In plasma samples of 60 patients (median age 49.5), we evaluated the following parameters 1)Markers of in vivo clotting activation thrombin-antithrombin complex (ELISA) and D-dimer (ELISA), 2) Natural anticoagulants (protein C [PC] and antithrombin III [AT III] by chromogenic methods). The coagulation studies were performed at the beginning and at the end of the first cycle of CMF protocol. RESULTS: Before CMF therapy, significant difference was observed between patients with early stage and patients with metastatic breast cancer in the PC (p<0.01), AT III (p<0.01) and TAT (p<0.01) levels. After CMF therapy, patients with stage II (adjuvant) disease manifested a significant decrease in the level of PC and AT III activity (p<0.01) and an increase in TAT level (p<0.01). In patients with disseminated breast cancer CMF therapy provoked an increased level of TAT and D-dimer with a decreased activity of protein C and antithrombin III. There was significant difference in value of TAT, D- dimer, protein C and antithrombin III between the patients with adjuvant and metastatic breast cancer patients after CMF chemotherapy CONCLUSION: Our results suggest that the application of cytotoxic therapy provokes hypercoagulable condition in breast cancer patients. This effect should be considered when chemotherapy is employed in advanced cancer patients at high risk for thrombosis, or in patients with other risk factors.

scholarly journals Comparative Study of Fibrinolytic Response amongst Malarious Pregnant and Non Malarious Subjects in Rivers State, Nigeria

2020 ◽  
pp. 34-45
Author(s):  
Stella Urekweru Ken-Ezihuo ◽  
Barinaaziga Sunday Mbeera ◽  
Chiatugu Nancy Ibeh ◽  
Zacchaeus Awortu Jeremiah
Keyword(s):  
Pregnant Women ◽  
Plasminogen Activator ◽  
Plasminogen Activator Inhibitor ◽  
Plasminogen Activator Inhibitor 1 ◽  
Port Harcourt ◽  
Tissue Plasminogen ◽  
Rivers State ◽  
Activator Inhibitor ◽  
Pai 1 ◽  
D Dimer

Aim: The study was designed to comparatively assess the degree of fibrinolytic response amongst   malaria-positive pregnant women, and non-malaria positive subjects in Rivers State, Nigeria. Methods: The study area covered University of Port Harcourt Teaching Hospital, Port Harcourt [UPTH] and Rivers State University Teaching Hospital, [RSUTH] both in Port Harcourt metropolis Rivers State.  It was a cross-sectional study carried out on a total of two hundred and forty female attendees at the obstetrics and gynecology clinics of the two hospitals. The subjects were grouped into three comprising of eighty subjects in each group; malarious pregnant women, non- malarious pregnant women and apparently healthy non-pregnant women. Venous blood sample measuring 5 milliliter volume was drawn from each subject, The sample was dispensed into two separate EDTA anticoagulant bottles, 3 milliliter and 2 milliliter meant for measuring the levels of markers of fibrinolysis which were Plasminogen, Plasminogen activator inhibitor-1, Plasminogen activator inhibitor-2, Tissue Plasminogen activator, alpha-2-antiplasmin, D-dimers and fibrinogen, and      preparation of blood films for malaria microscopy respectively. Results: Fibrinogen result; 760.44±16.18 ng/ml of malaria-positive pregnant women was elevated compared to the malaria-negative women; 697.70±18.84 ng/ml and the non-pregnant control values of 704.73±15.25 ng/ml. These values were significantly different [P<.011] between the study groups. Results of tissue plasminogen activator [tPA]; 46.39±2.69 ng/ml, D-dimer; 77.64±6.94 ng/ml, plasminogen activator inhibitor-1 [PAI-1]; 89.73±2.14 ng/ml, plasminogen activator inhibitor-2 [PAI-2]; 568.00±12.51 ng/ml, plasminogen; 23.82±0.75 ng/ml and 2-antiplasmin; 1314.06±34.64 ng/ml of the malaria-positive pregnant women were significantly different [P=0.0001] from  non-positive pregnant women; tPA; 28.87±1.38 ng/ml, D-dimer; 53.90±1.18 ng/ml., PAI-1; 80.00± 1.81 ng/ml, PAI-2; 456.31±5.94 ng/ml, Plasminogen; 16.63±0.67 ng/ml and 2-antiplasmin; 1130.61±29.74 ng/ml . Both results were significantly different [P=0.0001] from the non-pregnant control group; tPA; 31.34±1.64 ng/ml, D-dimer; 30.24±1.04 ng/ml, PAI-1; 65,47±2,33 ng/ml, PAI-2; 427.86±6.95 ng/ml, plasminogen; 16.49±0.04 ng/ml and 2-antiplasmin; 1016.98±24.51 ng/ml. Conclusion: The study witnessed significantly high concentrations of fibrinolytic markers in malaria-positive pregnant women. This could be due to compromised endothelial cell function resulting to overproduction of biomarkers of fibrinolysis. The implication is thrombus formation and excessive bleeding in pregnancy which could lead to miscarriages, fetal death or maternal mortality.

Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Julio Flores ◽  
Ángel García-Avello ◽  
Esther Alonso ◽  
Antonio Ruíz ◽  
Olga Navarrete ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Enzyme Linked Immunosorbent Assay ◽  
Diagnostic Utility ◽  
Tissue Plasminogen ◽  
D Dimer

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

A Specific Immunologic Assay for Functional Plasminogen Activator Inhibitor 1 in Plasma – Standardized Measurements of the Inhibitor and Related Parameters in Patients with Venous Thromboembolic Disease

1992 ◽  
Vol 68 (05) ◽  
pp. 486-494 ◽  
Author(s):  
Malou Philips ◽  
Anne-Grethe Juul ◽  
Johan Selmer ◽  
Bent Lind ◽  
Sixtus Thorsen
Keyword(s):  
Plasminogen Activator ◽  
Plasminogen Activator Inhibitor ◽  
Normal Subjects ◽  
Tissue Type ◽  
Blood Collection ◽  
Plasminogen Activator Inhibitor 1 ◽  
Type Plasminogen Activator ◽  
Significant Difference ◽  
Activator Inhibitor ◽  
Pai 1

SummaryA new assay for functional plasminogen activator inhibitor 1 (PAI-1) in plasma was developed. The assay is based on the quantitative conversion of PAI-1 to urokinase-type plasminogen activator (u-PA)-PAI-l complex the concentration of which is then determined by an ELISA employing monoclonal anti-PAI-1 as catching antibody and monoclonal anti-u-PA as detecting antibody. The assay exhibits high sensitivity, specificity, accuracy, and precision. The level of functional PAI-1, tissue-type plasminogen activator (t-PA) activity and t-PA-PAI-1 complex was measured in normal subjects and in patients with venous thromboembolism in a silent phase. Blood collection procedures and calibration of the respective assays were rigorously standardized. It was found that the patients had a decreased fibrinolytic capacity. This could be ascribed to high plasma levels of PAI-1. The release of t-PA during venous occlusion of an arm for 10 min expressed as the increase in t-PA + t-PA-PAI-1 complex exhibited great variation and no significant difference could be demonstrated between the patients with a thrombotic tendency and the normal subjects.

Fibrinolysis and Coagulation in Patients with Infectious Disease and Sepsis

1991 ◽  
Vol 65 (03) ◽  
pp. 291-295 ◽  
Author(s):  
J Philippé ◽  
F Offner ◽  
P J Declerck ◽  
G Leroux-Roels ◽  
D Vogelaers ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Plasminogen Activator ◽  
Protein C ◽  
Severe Infection ◽  
Plasminogen Activator Inhibitor ◽  
Tissue Type ◽  
Type Plasminogen Activator ◽  
Significant Difference ◽  
At Iii ◽  
C 30

SummarySepsis is often associated with hemostatic dysfunction. This study aimed to relate changes in fibrinolysis and coagulation parameters to sepsis and sepsis outcome. Urokinase-type plasminogen activator (u-PA) antigen, tissue-type plasminogen activator (t-PA) antigen and activity, plasminogen activator inhibitor (PAI) type 1 antigen, PAI activity, antithrombin (AT) III activity, and protein C activity were measured in 24 patients suffering from sepsis or septic shock and the results were compared with those observed in 30 non-sepsis patients with severe infectious disease. The u-PA level was markedly increased in plasma of sepsis patients as compared to non-sepsis patients (11.5 ± 9.4 versus 1.6 ± 1.5 ng/ml, p <0.0001). PAI-1 antigen and t-PA activity showed a significant increase in sepsis patients (320 ± 390 ng/ml versus 120 ± 200 ng/ml, and 3.0 ± 3.6 IU/ml versus 1.0 ± 0.7 IU/ml, respectively, p <0.01). AT III was decreased in sepsis patients (58 ± 28% in sepsis versus 79 ± 26% in severe infectious disease, p <0.01) as was protein C (30 ± 18% versus 58 ± 27%, p <0.001). No significant difference was found for t-PA antigen nor for PAI activity. Nonsurvivors of sepsis were distinguished mainly by a high u-PA antigen level and increased t-PA activity. It is concluded that plasma u-PA antigen showed the strongest significant difference, among the parameters evaluated, between sepsis and severe infection. u-PA antigen may be of prognostic value in patients admitted to the medical intensive care unit for severe infectious disease.

Predictive Value of Decreasing Antithrombin III in Deep-Vein Thrombosis

1980 ◽  
Vol 44 (03) ◽  
pp. 135-137 ◽  
Author(s):  
Thorkild Lund Andreasen
Keyword(s):  
Deep Vein Thrombosis ◽  
Predictive Value ◽  
Coronary Care Unit ◽  
Antithrombin Iii ◽  
Predictive Values ◽  
Vein Thrombosis ◽  
At Iii ◽  
Coronary Care ◽  
Time Of Admission ◽  
Deep Vein

SummaryAntithrombin III (At-III) was measured at the time of admission and two days later in 131 patients laid up in a coronary care unit. The patients were examined for deep-vein thrombosis (DVT) clinically and by means of 125I-fibrinogen scanning. 19 patients developed DVT. In 11 subjects with and 25 without DVT At-III decreased more than 10%. And in 7 with and 17 without DVT At-III decreased more than 15%. One person with DVT had subnormal At-III. By using decrease of At-III or subnormal initial At-III to predict DVT the following predictive value (PV) were found. Decrease ≤ 10%, PV pos.= 0.32 and PV neg. = 0.93. Decrease ≤ 15%, PV pos. = 0.32 and PV neg. = 0.90. The positive predictive values obtained were too low to let decreasing At-III give occasion for prophylactic anticoagulant treatment.

scholarly journals Efficiency of non-invasive prenatal screening in pregnant women at advanced maternal age

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hui Zhu ◽  
Xiaoxiao Jin ◽  
Yuqing Xu ◽  
Weihua Zhang ◽  
Xiaodan Liu ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Predictive Value ◽  
Trisomy 21 ◽  
Maternal Age ◽  
Prenatal Screening ◽  
Advanced Maternal Age ◽  
Youden Index ◽  
Non Invasive ◽  
Sensitivity Specificity

Abstract Background Non-invasive prenatal screening (NIPS) is widely used as the alternative choice for pregnant women at high-risk of fetal aneuploidy. However, whether NIPS has a good detective efficiency for pregnant women at advanced maternal age (AMA) has not been fully studied especially in Chinese women. Methods Twenty-nine thousand three hundred forty-three pregnant women at AMA with singleton pregnancy who received NIPS and followed-up were recruited. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), receiver operating characteristic (ROC) curves and the Youden Index for detecting fetal chromosomal aneuploidies were analyzed. The relationship between maternal age and common fetal chromosomal aneuploidy was observed. Results The sensitivity, specificity, PPV, NPV of NIPS for detecting fetal trisomy 21 were 99.11, 99.96, 90.98, and 100%, respectively. These same parameters for detecting fetal trisomy 18 were 100, 99.94, 67.92, and 100%, respectively. Finally, these parameters for detecting trisomy 13 were 100, 99.96, 27.78, and 100%, respectively. The prevalence of fetal trisomy 21 increased exponentially with maternal age. The high-risk percentage incidence rate of fetal trisomy 21 was significantly higher in the pregnant women at 37 years old or above than that in pregnant women at 35 to 37 years old. (Youden index = 37). Conclusion It is indicated that NIPS is an effective prenatal screening method for pregnant women at AMA.

PREDICTIVE VALUE OF LOW AT III LEVELS FOR THE OCCURRENCE OF IVH, IRDS AND DEATH IN PREMATURE NEONATES

1987 ◽  
Author(s):  
W van den Berg ◽  
M Peters ◽  
C Breederveld ◽  
J W ten Cate ◽  
J G Koppe
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Distress Syndrome ◽  
Peripheral Vein ◽  
Premature Neonates ◽  
Significant Difference ◽  
At Iii ◽  
Diffuse Intravascular Coagulation ◽  
Idiopathic Respiratory Distress Syndrome ◽  
A Prospective Study

The observation of AT III deficiency in premature neonates with Idiopathic Respiratory Distress Syndrome (IRDS), suggests a positive predictive value for a poor outcome. The underlying diffuse intravascular coagulation could generate serious hemorrhagic complications like Peri/Intraventricular Hemorrhage (IVH).A prospective study was performed in consecutively born neonates to assess the predictive value of low AT III for theoccurrence of IVH, (gr. III/IV), IRDS, and death. Eighty-one neonates were included in the study during a period of 5 months. AT III levels were determined immediately after birth by a chromogenic substrate assay. Values in umbilical cord blood were identical with values in capillary or peripheral vein blood samples taken within 6 hours after birth. There was no correlation between AT III values and gestational age (r: 0.18). Twenty-four neonates with IRDS showed a mean AT III value of 0.23 U/ml (S. D. ± 0.07 U/ml) which was significantly lower than a mean AT III value of 0.35 U/ml (S. D. ± 0.1 U/ml) for neonates without IRDS (p ≺0.00005). When IVH gr. III/IV was diagnosed in neonates having IRDS (8/24) no significant difference in mean AT IIIact was observed with respect to jnean AT III levels of remaining neonates without this complication. No death occurred in neonates without IRDS. Mean AT IIIact (0.21 U/ml) in neonates with IRDS who died (9/24) was low compared with mean AT III levels of neonates with IRDS who survived (0.25 U/ml), but did not reach significance (p≻0.1). Assuming a critical value of AT III of 20% a positive predictive value of 89% for IRDS, 44% for IVH, and 56% for death was calculated. It is concluded that low AT Illact levels have a high predictive value for IRDS.

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