Association of Elevated Soluble P-Selectin Levels and Fetal Loss in Women with a History of Venous Thromboembolism.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1809-1809
Author(s):  
Cihan Ay ◽  
Alexandra Kaider ◽  
Silvia Koder ◽  
Peter Husslein ◽  
Ingrid Pabinger
Keyword(s):  
Venous Thromboembolism ◽  
Pregnancy Complications ◽  
Plasma Levels ◽  
Fetal Death ◽  
Fetal Loss ◽  
Intrauterine Fetal Death ◽  
Significant Difference ◽  
History Of ◽  
Study Population ◽  
Soluble P

Abstract Pregnancy is a hypercoagulable state with an increased risk of venous thromboembolism (VTE). Furthermore, accumulating evidence support the hypothesis that pregnancy complications such as fetal loss are associated with both inherited and acquired thrombophilic defects which may predispose to thrombosis of the placental vasculature and lead to subsequent fetal loss. In recent studies the cell adhesion molecule P-selectin has been identified to be a strong risk factor for VTE. Interestingly, soluble P-selectin (sP-selectin) plasma levels were previously reported to increase during pregnancy. Whether P-selectin is also associated with fetal loss in women with a history of venous thromboembolism, is not known yet. Therefore, the aim of our present study was to investigate the significance of elevated sP-selectin levels for fetal loss (e.g. miscarriage or stillbirth) in women with a history of VTE. We retrospectively evaluated data on pregnancy-associated complications in 304 women (mean age [+/-SD]: 45.6 [+/-11.5] yrs) with a history of VTE. sP-selectin plasma levels were measured using a sensitive ELISA (sP-selectin Immunoassay, R&D Systems®, Minneapolis, MN, USA). At the time of measurement of sP-selectin none of the women was pregnant and did not have an acute event of VTE. The mean age (±SD) of patients at the time of the VTE event was 31.3 (+/- 8.4) yrs. The prevalence of miscarriage (defined as intrauterine fetal death before the 24th week of gestation or when fetus weighed <500 g) in our study population was 21.8% and the prevalence of stillbirth (defined as intrauterine fetal death at or after the 24th week of gestation) was 4.3%. Median (interquartile range [IQR]) sP-selectin level of the total study population was 38.0 [21.7-44.4] ng/mL. The cut-off point for elevated sP-selectin was set at 44.4 ng/mL, which represents the 75th percentile of sP-selectin levels of the study population. The prevalence of stillbirth was significantly higher in subjects with elevated sP-selectin levels compared to those with lower levels (10.5% vs. 2.6%, p=0.008), whereas no statistically significant difference in prevalence of miscarriage was observed between women with and without elevated sP-selectin (17.1% vs. 22.9%, p=0.303). The odds ratio [95% CI] of elevated sP-selectin for stillbirth was 4.2 [1.5-12.7] and for miscarriage 0.7 [0.4-1.3]. In summary, elevated sP-selectin plasma levels were associated with a 4-fold risk for stillbirth in women with a history of VTE. Our data support a possible role of P-selectin in the aetiology of late pregnancy complications.

Association of elevated soluble P-selectin levels with fetal loss in women with a history of venous thromboembolism

2012 ◽  
Vol 129 (6) ◽  
pp. 725-728 ◽  
Author(s):  
Cihan Ay ◽  
Alexandra Kaider ◽  
Silvia Koder ◽  
Peter Husslein ◽  
Ingrid Pabinger
Keyword(s):  
Venous Thromboembolism ◽  
Fetal Loss ◽  
History Of ◽  
Soluble P

Factor V Leiden Is Associated with Repeated and Recurrent Unexplained Fetal Losses

1997 ◽  
Vol 77 (05) ◽  
pp. 0822-0824 ◽  
Author(s):  
Elvira Grandone ◽  
Maurizio Margaglione ◽  
Donatella Colaizzo ◽  
Marina d'Addedda ◽  
Giuseppe Cappucci ◽  
...  
Keyword(s):  
Protein C ◽  
Strong Association ◽  
Activated Protein C ◽  
Fetal Loss ◽  
Factor V Leiden ◽  
Factor V ◽  
Significant Difference ◽  
History Of ◽  
Fv Leiden ◽  
Caucasian Women

SummaryActivated protein C resistance (APCR) is responsible for most cases of familial thrombosis. The factor V missense mutation Arg506>Gln (FV Leiden) has been recognized as the commonest cause of this condition. Recently, it has been suggested that APCR is associated with second trimester fetal loss. We investigated the distribution of FV Leiden in a sample (n = 43) of Caucasian women with a history of two or more unexplained fetal losses. A group (n = 118) of parous women with uneventful pregnancies from the same ethnical background served as control. We found the mutation in 7 cases (16.28%) and 5 controls (4.24%; p = 0.011). A statistically significant difference between women with only early fetal loss vs those with late events (p = 0.04) was observed. Our data demonstrate a strong association between FV Leiden and fetal loss. Furthermore, they indicate that late events are more common in these patients.

Unexplained fetal death: Are women with a history of fetal loss at higher risk?

2009 ◽  
Vol 49 (2) ◽  
pp. 151-157 ◽  
Author(s):  
Mary-Anne MEASEY ◽  
Edouard TURSAN d’ESPAIGNET ◽  
Adrian CHARLES ◽  
Catherine DOUGLASS
Keyword(s):  
Fetal Death ◽  
Fetal Loss ◽  
History Of

Thromboprophylaxis for recurrent miscarriage in women with or without thrombophilia

2011 ◽  
Vol 105 (02) ◽  
pp. 295-301 ◽  
Author(s):  
Jantien Visser ◽  
Veli-Matti Ulander ◽  
Frans Helmerhorst ◽  
Katja Lampinen ◽  
Laure Morin-Papunen ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Live Birth ◽  
Pregnancy Complications ◽  
Birth Rate ◽  
Neonatal Outcome ◽  
Recurrent Miscarriage ◽  
Fetal Loss ◽  
Live Birth Rate ◽  
First Trimester ◽  
Significant Difference

SummaryRecurrent miscarriage affects 1–2% of women. In more than half of all recurrent miscarriage the cause still remains uncertain. Thrombophilia has been identified in about 50% of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment. A randomised double-blind (for aspirin) multicentre trial was performed among 207 women with three or more consecutive first trimester (<13 weeks) miscarriages, two or more second trimester (13–24 weeks) miscarriages or one third trimester fetal loss combined with one first trimester miscarriage. Women were analysed for thrombophilia. After complete work-up, women were randomly allocated before seven weeks’ gestation to either enoxaparin 40 mg and placebo (n=68), enoxaparin 40 mg and aspirin 100 mg (n=63) or aspirin 100 mg (n=76). The primary outcome was live-birth rate. Secondary outcomes were pregnancy complications, neonatal outcome and adverse effects. The 0.92–1.48] was found for enoxaparin and placebo and 65% [RR 1.08, 95% CI 0.83–1.39] for enoxaparin and aspirin when compared to aspirin alone (61%, reference group). In the whole study group the live birth rate was 65% (95% CI 58.66–71.74) for women with three or more miscarriages (n=204). No difference in pregnancy complications, neonatal outcome or adverse effects was observed. No significant difference in live birth rate was found with enoxaparin treatment versus aspirin or a combination of both versus aspirin in women with recurrent miscarriage.

scholarly journals Evaluation of factor VIII value in normal women and whom encountered recurrent pregnancy loss: is there any significant difference?

2020 ◽  
Vol 9 (3) ◽  
pp. 1034
Author(s):  
Douaa Al Rez ◽  
Hasan Naser Eldine ◽  
Marwan Alhalabi
Keyword(s):  
Factor Viii ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Fetal Loss ◽  
Control Group ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of ◽  
Normal Women ◽  
High Level

Background: Recurrent pregnancy loss (RPL) is a serious problem on the women, it defined as two or more consecutive pregnancy losses before the fetus has reached birth. The aim of this study is to evaluate the association between the elevation in the factor VIII and RPL. Because women who have thrombophilia have increased risk of fetal loss in most studies.Methods: A total 72 women were recruited in this case control study. They divided into two groups: the RPL group included 41 women with a history of recurrent pregnancy loss and the control group included 31 healthy women, who had at least one successful pregnancy and none of them had a history of fetal loss or complicated pregnancy.Results: A majority of the patients of this study didn't have a high level of factor VIII, 9 of 41 (22%) patients of RPL group in comparison with 21 of 32 (65,6%) of control group, that suffer from the increase rate of FVIII, this means that factor VIII doesn't effect on RPL.Conclusions: The present study showed that the serum elevation in the factor VIII is not significantly associated with RPL.

Evidence of Increased Plasma Coagulative Capacity by CloFAL Assay among Pediatric Factor V Leiden and Prothrombin G20210A Heterozygotes with, Versus without, a First-or Second-Degree Family History of Venous Thromboembolism

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5345-5345
Author(s):  
Chris Bombardier ◽  
Linda J. Jacobson ◽  
Marilyn J. Manco-Johnson ◽  
Neil A Goldenberg
Keyword(s):  
Venous Thromboembolism ◽  
Family History ◽  
Positive Family History ◽  
Personal History ◽  
Clot Formation ◽  
Factor V ◽  
History Of ◽  
Study Population ◽  
Fv Leiden ◽  
Thrombophilia Testing

Abstract BACKGROUND: The factor V (FV) Leiden and prothrombin (PT) G20210A polymorphisms in heterozygous state are present in 5% and 1–2% of Caucasians, respectively, and confer approximately 5-fold and 2-fold increases in the risk of incident venous thromboembolism (VTE). While some families who carry these genetic thrombophilia traits exhibit a prothrombotic phenotype, others have no (or only a limited) history of VTE. The ability to discern which individuals with personal and familial carriage of these genetic thrombophilias possess a clinically meaningful increase in VTE risk remains elusive, and (particularly among children) is perhaps best informed presently by family history of VTE. OBJECTIVE AND HYPOTHESES: We sought to evaluate overall plasma coagulative capacity in FV Leiden and PT G20210A heterozygotes using the Clot Formation and Lysis (CloFAL) assay, a global turbidimetric plasma assay of tissue-factor induced fibrin clot formation and tissue-type plasminogen activator enhanced fibrinolysis. We hypothesized that children heterozygous for either thrombophilia would not uniformly demonstrate hypercoagulability, but that coagulative capacity would be increased among heterozygotes who have a family history of VTE. PATIENTS AND METHODS: Children aged birth to 18 years (inclusive) enrolled in prospective inceptional cohort study of thrombosis/thrombophilia/stroke were included in the analysis if they were found to be heterozygous for FV Leiden or PT G20210A upon comprehensive thrombophilia testing and had undergone CloFAL assay testing on a research basis. Data on personal and family history of thrombotic events, thrombophilia testing, and CloFAL assay findings were analyzed. Intergroup comparisons of continuous data were performed by Mann-Whitney U test and proportions were compared between groups using chi-square or Fisher’s exact test, as appropriate. RESULTS: Characteristics of the study population are shown in Table 1. Approximately 70% of patients were evaluated for a family history of VTE (with/without known thrombophilia) and nearly 50% had personal histories of VTE or arterial ischemic stroke (AIS)/recurrent transient ischemic attack (TIA); those evaluated for events were significantly older than those without events, and this difference was statistically significant among those with a positive family history fo VTE. Hypercoagulability was shown in 50% of patients and hypofibrinolysis in 13% using the CloFAL assay. Plasma coagulative capacity and maximal amplitude (MA) of the CloFAL waveform were significantly increased in patients with, versus without, family history of VTE (coagulation index, CI: 102% vs. 72% of the adult normal pooled plasma standard, respectively, p=0.04; MA: 0.415 vs. 0.322, p=0.02), and were not explained by age differences between groups. However, in this relatively small study population, the proportion of CloFAL CI results that exceeded the upper limit of normal values did not significantly differ between those with, versus without, family history of VTE. Pediatric FV Leiden or PT G20210A heterozygotes with positive family history of VTE were more likely to have multi-trait (&gt;1) thrombophilia, in which case a trend toward increased plasma coagulability was demonstrated (CI: 139% [multi-trait] vs. 86% [isolated trait]; p=0.07); superimposed thrombophilias in this group most often consisted of elevated factor VIII activity and Lp(a) concentration. CONCLUSIONS: The present findings using the CloFAL global assay indicate that, while pediatric FV Leiden or PT G20210A heterozygotes do not uniformly exhibit hypercoagulability, plasma coagulative capacity is nevertheless significantly increased among heterozgyotes who have a family history of VTE, which may relate to the presence of superimposed thrombophilias. Table 1. Summary characteristics of the study population. *VTE, AIS, or recurrent TIA **Two patients were dual heterozygotes. N 32 Median age at evaluation (range) 9.5 y (1–18 y) Personal history of events* 14 y (1–18 y) No personal history of events* 8 y (2–18 y) FV Leiden heterozygote (n) 26** PT G20210A heterozygote (n) 8** Personal history of VTE (n) 11 Personal history of AIS/recurrent TIA 4 Family history (1st/2nd degree) of VTE 71% Multi-trait (&gt;1) thrombophilia 45% Acquired thrombophilia 24% Hypercoagulability by CloFAL assay 50% Hypofibrinolysis by CloFAL assay 13%

scholarly journals Do Current Antiphospholipid Antibody Syndrome Guidelines Effectively Target at-Risk Obstetric Patients?

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1208-1208
Author(s):  
Kanika Thapar ◽  
Nimesh Patel ◽  
Bolanle Gbadamosi ◽  
Daniel E Ezekwudo ◽  
Ishmael Jaiyesimi ◽  
...  
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Gestational Age ◽  
Fetal Loss ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Recurrent Fetal Loss ◽  
Clinical Criteria ◽  
Significant Difference ◽  
Positive Results

Abstract Introduction: The incidence of spontaneous miscarriages is 1%, and up to 50% of recurrent fetal losses (RFL) have unclear etiology. Antiphospholipid syndrome (APS) has been reported in 5-15% of women with RFL. Current clinical criteria for APS include venous thromboembolism (VTE) and /or fetal loss. In addition to the clinical criteria, laboratory confirmation must be obtained using tests for lupus anticoagulant (LA), anticardiolipin (ACL) and beta-2 glycoprotein I antibodies (β2GPI). These tests are often provided by many laboratories as panels; moreover, given the relatively large number of tests, judicious ordering of these panels is warranted to contain costs and to avoid mislabeling patients who have clinically insignificant positive results. Some existing literature suggests that patients with recurrent fetal loss and ACL antibodies are over-tested and/or over-diagnosed. We aim to determine the frequency and likelihood of positive antiphospholipid antibody (APA) among patients with fetal loss. Materials and Methods: A retrospective search was conducted for APA panels using data from our laboratory information system from Jan 2014 to Jan 2015. Recorded variables included age, ordering physician subspecialty and indication for testing. For patients with fetal loss, the number of losses and gestational age at the time of loss were recorded. Specimens were classified as positive, indeterminate or negative. For positive and indeterminate tests, the results of LA, ACL, and β2GPI antibody tests and titers were noted. Results: Our search identified 430 panels ordered for APA. The median age was 42 (range: 1-92). The three highest ordering physician subspecialties were Ob/Gyn (20.2%), Internal Medicine (17.7%) and Heme/Onc (17.2%). The three most common indications for ordering the APA panel were venous thromboembolism (26.5%), fetal loss (18.4%), and autoimmune disease (15.4%). The largest percentage of positive results came from panels ordered by Heme/Onc 45% (20/44) and for the indication of VTE 40.9% (18/44). Fetal loss (n=74) accounted for 4.5% (2/44) of positive results. Further investigation of the fetal loss cases showed that 82.4 % (61/74) met criteria for appropriate APA testing. There was no statistically significant difference for gestational age < 10 weeks (1 positive, 4 indeterminate, and 30 negative specimens) or > 10 weeks (1 positive, 1 indeterminate, and 37 negatives; p=0.334); ordering physician subspecialty and the APA testing result. Both fetal loss patients that tested positive for APS had increased titers of ACL IgM and β2GPI IgM. Conclusions: Despite being the second most common indication for APA testing, fetal loss only accounted for 4.5% of positive results. Compared to historical data that report an incidence of 5-15% APS in patients with recurrent fetal loss, we found an incidence of only 2.7%. The reason for this discrepancy is not clear. Confounding factors such as inappropriate work-ups or incomplete testing are unlikely as 82.7% of patients meet standard testing criteria and our APA panels included multiple tests for LA, ACL and β2GPI. Larger studies are needed to confirm our findings, as this may call for redefinition of APA testing guidelines to better target at risk obstetric patients. Disclosures No relevant conflicts of interest to declare.

A 2- TO 3-YEAR OUTCOME AFTER BRONCHIOLITIS

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 254-254
Author(s):  
Nancy Ostrom
Keyword(s):  
Family History ◽  
Positive Family History ◽  
Control Group ◽  
Short Term ◽  
Term Outcome ◽  
Significant Difference ◽  
Socioeconomic Diversity ◽  
History Of ◽  
Study Population ◽  
Viral Etiologies

Purpose of the Study. To evaluate risk factors and short term outcome for subsequent wheezing in children with early bronchiolitis or pneumonia. Study Population. One hundred twenty-seven children (0 to 2 years old) hospitalized for wheezing (83) or pneumonia in a 1-year period in two hospitals in Finland. Methods. Patients with a history of hospitalization for wheezing with respiratory infection (including bronchiolitis) versus pneumonia were examined, and their parents were interviewed at 1 month, 1.5 to 2 years, and 2.5 to 3 years. Family history of atopy, environmental factors, breast feeding history, and other atopy (eczema, elevated IgE) were noted using a standardized questionnaire and physician-documented wheezing episodes were quantified. Statistical χ2 tests were analyzed comparing the wheezing group to the control group of patients with pneumonia not associated with wheezing. Findings. There was no significant difference between the groups in bacterial versus viral etiology of their lower respiratory symptoms. Subsequent wheezing after bronchiolitis occurred in 76% of children 1-2 years of age and 58% of children at 2-3 years of age. This compares with 9% and 16% (respectively by age) of the group with "non-wheezing" pneumonia. Atopic diathesis, particularly a positive family history of asthma was the host factor best associated with initial wheezing. Parenthetically, parental smoking was found in 61% of the wheezing group and 45% of the pneumonia group. Reviewer's Comments. This is a sound study, perhaps limited, in its comparability to our clinical populations with wider racial and socioeconomic diversity. Of note is the finding of no differences between the wheezing and nonwheezing groups in bacterial and viral etiologies.

High Plasma Levels of Soluble P-Selectin Are Predictive for Venous Thromboembolism in Cancer Patients - Results from the Vienna Cancer and Thrombosis Study (CATS).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 701-701
Author(s):  
Cihan Ay ◽  
Ralph Simanek ◽  
Rainer Vormittag ◽  
Daniela Dunkler ◽  
Guelay Alguel ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Plasma Levels ◽  
High Plasma ◽  
Cumulative Probability ◽  
Total Study Population ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Soluble P ◽  
Observation Period

Abstract Cancer patients are at high risk for venous thromboembolism (VTE), which represents an additional burden and a frequent cause of increased mortality. Laboratory parameters with a predictive value for VTE could help to assign a patient to a high or low risk group. In recent studies the cell adhesion molecule P-selectin was identified to be a strong risk factor for VTE. However, the role of soluble P-selectin (sP-selectin) in cancer-associated VTE is not known because up to now clinical data are not available. Therefore, we assessed sP-selectin plasma levels in cancer patients as a risk predictor for VTE and provide a report from the ongoing prospective observational CATS. Patients with newly diagnosed cancer or progression of disease who had no chemotherapy within the last three months were enrolled from October 2003 to October 2006 and followed prospectively via phone and mail. Occurrence of VTE and information on the patientś anti-cancer-treatment within the follow up period were recorded. VTE has always been confirmed by imaging. sP-selectin levels were measured with a highly sensitive ELISA. Kaplan Meier and Cox regression analysis were applied for statistical calculation. We included 687 patients (319 female/368 male, median age [IQR]: 62 [54–68] yrs) with malignant disease and followed them for a median observation period of 415 days. Main tumour entities were malignancies of the breast (n=125), lung (n=86), upper (n=30) and lower gastrointestinal tract (n=100), pancreas (n=42), kidney (n=19) and prostate (n=72). Furthermore, 80 patients had high-grade glioma, 73 lymphomas, 18 multiple myeloma and 42 other tumour types. Distant metastases were found in 268 patients at the time of recruitment. During the observation period VTE occurred in 45 patients (21 female/24 male, median age [IQR]: 62 [48–66] yrs). Elevated plasma levels of sP-selectin (cut-off level 53.1 ng/mL representing the 75th percentile of the total study population, 173 patients) [hazard ratio (HR): 2.5, 95% CI 1.4 – 4.6], surgery [HR: 3.9, 95% CI 1.8 – 8.5] and radiotherapy [HR: 3.2, 95% CI 1.6 – 6.4] were statistically significant risk factors for VTE in multivariable analysis including sP-selectin, age, sex, surgery, chemotherapy and radiotherapy. The cumulative probability of VTE after 6 months was 11.9% in patients with sP-selectin plasma levels above and 3.7% in those below the 75th percentile. In conclusion, high plasma levels of sP-selectin independently predict VTE in cancer patients. Measurement of sP-selectin at diagnosis of cancer would help to identify patients at increased risk for VTE.

Protein-Z Deficiency and/or Protein Z Polymorphisms in First Trimester Pregnancy Complications

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1221-1221
Author(s):  
Maria Topalidou ◽  
Vassilios K Papadopoulos ◽  
Zoi Mpousiou ◽  
Haris Kartsios ◽  
Kyriaki Kokoviadou ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Fetal Loss ◽  
First Trimester ◽  
Spontaneous Abortions ◽  
Protein Z ◽  
Increased Risk ◽  
Significant Difference ◽  
Group B

Abstract Abstract 1221 INTRODUCTION: Protein Z (PZ) is a vitamin K-dependent coagulation factor; it is a glycoprotein that inhibits activated factor Xa, acting as a co-factor to PZ-dependent protease inhibitor, enhancing its action approximately by 1000 times. PZ levels in normal individuals vary greatly, as a result of PZ gene polymorphisms. PZ deficiency has been involved in the pathogenesis of ischemic strokes and pregnancy complications. Gris et al [Blood 2002;99(7):2606–08] first described a possible role of PZ deficiency (PZ <= 1mg/L) in women with fetal loss between the beginning of the 10th and the end of the 15th week of gestation. In a recent meta-analysis [Sofi et al, Thrombosis and Haemostasis 2010;103(4):749–56] PZ deficiency was associated with increased risk of pre-eclampsia and fetal loss, as well as with increased risk of arterial and venous thrombotic events. MATERIALS-METHODS: We studied a total of 314 women, 70 women with three or more consecutive spontaneous abortions (group A), 145 women with less than 3 early spontaneous abortions (group B) and 99 control women with at least one normal pregnancy and negative history of a thrombotic complication (group C). All women were tested for congenital and acquired thrombophilia such as antithrombin, protein C and S levels, homocysteine levels, lupus anticoagulant (PTTLa), factor V Leiden mutation, prothrombin G20210A gene polymorphism and PZ levels. We also investigated protein Z polymorphism F79A in a subgroup of our patients. Measurements were made at least 3 months apart from a thrombotic event. Differences between groups were assessed with ANOVA and chi-squared tests for continuous and categorical variables respectively. RESULTS: Statistically significant difference was found in PZ levels between the three groups. Mean PZ level was 1.23mg/dL, 1.31mg/dL και 1.61mg/dL (p<0.00001) in groups A, B, C respectively. Post-hoc Bonferroni analysis revealed a significant difference between groups A and C (p=0.0003) and between groups B and C (p=0.001). The percentage of PZ deficiency (95% condidence interval) was 40% (28%–52%), 38% (30%–46%) and 18% (11%–26%) respectively (p=0.001). Both group A (OddsRatio[OR]=3) and group B (OR=2.75) have a statistically greater PZ deficiency than control group C. The other parameters did not differ significantly between the three groups. DISCUSSION/CONCLUSIONS: Spontaneous abortions are common in women especially in first trimester. Thrombophilia has a major role in pregnancy complications. In these women that one cannot find some of the well established thrombophilic factors, searching for other possible deficiencies is necessary. The role of PZ deficiency has been investigated thoroughly in the last decade with sometimes conflicting results. To the best of our knowledge, this is the first Greek study investigating the possible role of protein Z deficiency in women with early pregnancy losses. From our study it is evident that PZ deficiency is an independent risk factor for early pregnancy losses. From our study it seems that the other thrombophic factors may play a minor role. A plausible pathophysiologic explanation is the occurrence of microthrombi due to atherosclerotic lesions soon after the development of materno-placental circulation. The role of PZ gene polymorphisms in PZ levels and in thrombotic complications remains to be investigated further. According to preliminary results from a sub-group of our patients (Topalidou et al, Thrombosis Research 2009;124:24–27), the presence of the intron F79A polymorphism was associated with significantly lower PZ levels, but was unrelated to unexplained early pregnancy losses. Disclosures: No relevant conflicts of interest to declare.

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