Changes in thrombin generation and D-dimer concentrations in women injecting enoxaparin during pregnancy and the puerperium

• Published in: BMC pregnancy and childbirth 2014-11, Vol.14 (1), p.384-384, Article 384
• Main Authors: Patel, Jignesh P, Patel, Raj K, Roberts, Lara N, Marsh, Michael S, Green, Bruce, Davies, J Graham, Arya, Roopen
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anticoagulants - administration & dosage; Automation; Biomedical research; Black People; Caribbean Region - ethnology; Drug therapy; Enoxaparin - administration & dosage; Female; Fibrin Fibrinogen Degradation Products - metabolism; Hormone replacement therapy; Humans; Medical research; Middle Aged; Molecular weight; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular - drug therapy; Pregnancy Complications, Cardiovascular - prevention & control; Pregnancy Trimester, First - blood; Pregnancy Trimester, Second - blood; Pregnancy Trimester, Third - blood; Prenatal Care; Studies; Thrombin - biosynthesis; Thrombosis; Venous Thromboembolism - drug therapy; Venous Thromboembolism - prevention & control; White People; Womens health; Young Adult
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-014-0384-0

It is well accepted that the gravid state is hypercoagulable and a significant cause of both maternal morbidity and mortality in the Western world. Although thrombin generation is reported to be increased in pregnant women, uncertainty exists on the pattern of thrombin generation change during this time. The aim of this study is to describe thrombin generation changes and D-dimer concentrations in women injecting enoxaparin during pregnancy the postnatal period. One hundred and twenty-three women injecting enoxaparin had their thrombin generation, as measured by Calibrated Automated Thombinography (CAT), repeatedly assayed during pregnancy, once in each trimester, at delivery and 8 weeks post-partum. Furthermore, to understand the impact enoxaparin has on D-dimer concentrations during pregnancy, D-dimer concentrations were measured monthly in the recruited women. Thrombin generation was found to increase in the first trimester (mean endogenous thrombin potential (ETP): 1391 nmol/L.min), further increasing during the second trimester (mean ETP: 1757 nmol/L.min), after which it plateaued through to delivery, where it peaked (mean ETP: 1857 nmol/L.min) and then fell back at 8 weeks post-partum (ETP: 1293 nmol/L.min). In contrast D-dimer concentrations increased exponentially during the antenatal period, despite the enoxaparin prescription. Our results provide further evidence on alterations of thrombin generation during pregnancy and the postnatal period.