D-dimer ELISA for biological control of low molecular weight heparin treatment during pregnancy
Keywords:
PREGNANCY, THROMBOPHILIA, LOW MOLECULAR WEIGHT HEPARIN, ELISA TESTAbstract
The condition of pregnant women with thrombophilia under low molecular weight heparin (HBPM) is special, there are few studies on D-dimer levels in patients cursing pregnancy with no complications.
This retrospective study aims at: a) to show expected levels of D-dimer Elisa in women cursing the first three months of pregnancy under HBPM treatment with no complications and successful pregnancy, and b) to show D-dimer Elisa as warning signs of obstetric complications.
The study included 113 women with proved trombophile and a risk obstetric history cursing pregnancy under HBPM treatment with no complications and successful pregnancy. They were all monthly controlled with D-dimer ELlSA.
Results showed that levels of D-dimer ELlSA significantly increased as pregnancy developed. Cut-points for the different "kit" are useful to assess hemostasis, especially during the second and third months when women under HBPM treatment reached those cut-points.
Median and 10 and 90 percentil were calculated for each react, different curves were considered in order to determine D-dimer levels during pregnancy under HBPM treatment.
A 90 percentil cut-point is suggested for each react. D-dimer ELlSA high levels might suggest the need of therapeutic measures to prevent obstetric complications as it is seen in four patients discussed in the paper.
References
1) Stirrat GM. Recurrent miscarriage. Lancet 1990; 336 (8717): 673-5.
2) Bick RL, Madden J, Heller KB. Recurrent miscarriage: causes, evaluation and treatment. Medscape Womens Health 1998; 3(3): 2.
3) Soulier J, Boffa MC. Avortements a repetition thromboses et anticoagulant circulant antithromboplastine: Trois observations. Nouv Press Med 1980; 9: 859.
4) Amout J. Antiphospholipid syndrome: diagnostic aspects of lupus anticoagulant. Thromb Haemost 2001; 86(1): 83-91.
5) Greer IA. The challenge of thrombophilia in maternal-fetal medicine. N Engl J Med 2000; 342(6): 424-5.
6) Rosove M, Tabsh B, Wasserstrum N, Howard P, Hahn B, Kalunian K. Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet Gynecol 1990; 75(4): 630-4.
7) Many A, Pauzner R, Carp H, Langevitz P, Martinowitz U. Treatment of patients with antiphospholipid antibodies during pregnancy. Am J Reprod Immunol 1992; 28(3-4): 216-8.
8) Kobayashi S, Tamura N, Tsuda H, Mokuno C, Hashimoto H, Hirose S. Immunoadsorbent plasmapheresis for a patient with antiphospholipid syndrome during pregnancy. Ann Rheum Dis 1992; 51(3): 399-401.
9) Otero AM, Pou Ferrari R, Dellepiane M, Muxi P, De Lisa E, Attarian D, et al. Pregnancy outcome in women with recurrent pregnant loss treated with enoxa-parine. Trombosis and Haemostasis. Suppl. July 2001. SIN 0340 – 6245).
10) Biasiutti FD, Strebel JK. Anticoagulation and antiaggrega-tion during pregnancy. Ther Umsch 2003; 60(1): 54-8.
11) Gebhardt GS, Hall DR. Inherited and acquired thrombophilias and poor pregnancy outcome: should we be treating with heparin?. Curr Opin Obstet Gynecol 2003;15(6): 501-6.
12) Gris JC, Mercier E, Quere I, Lavigne-Lissalde G, Cochery-Nouvellon E, Hoffet M, et al. Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood 2004;103(10): 3695-9.
13) Galli M, Barbui T. Antiphospholipid antibodies and pregnancy. Best Pract Clin Haematol 2003;16(2): 211-25.
14) Carp H, Dolitzky M, Inbal A. Thromboprophylaxis improves the live birth rate in women with consecutive recurrent miscarriages and hereditary thrombophilia. J Thromb Haemost 2003; 1(3): 433-8.
15) Alarcon-Segovia D, Boffa MC, Branch W, Cervera R, Gharavi A, Khamashta M, et al. Prophylaxis of the antiphospholipid syndrome: a consensus report. Lupus 2003; 12(7): 499-503.
16) Copplestone JA, Pavord S, Hunt BJ, The Obstetric Haematology Group of the British Society for Haematology. Anticoagulation in pregnancy: a survey of current practice. Br J Haematol 2004; 124(1): 124-5.
17) Otero AM, Pou Ferrari R, Pons E, Storch E, Alonso J, De Lisa E, et al. Enoxaparina y aspirina a bajas dosis en el tratamiento de los síndromes antifosfolipídicos del embarazo. Seguridad y utilidad. Arch Med Int 2005; 27(2-3): 41-5.
18) Alhenc-Gélas M, Jestin-Le Guernic C, Vitoux JF, Kher A, Aiach M, Fiessinger JM. Adjusted versus fixed doses of low molecular weight heparin fragmin in the treatment of deep venous thrombosis. Fragmin-Study Group. Thromb Haemost 1994; 71(6): 698-702.
19) Leizorovicz A, Bara L, Samama MM, Haugh MC. Factor Xa inhibition: correlation between the plasma levels of anti-Xa activity and occurrence of thrombosis and haemorrhage. Haemostasis 1993; 23 Suppl 1: 89-98.
20) Sociedad de Hematología del Uruguay, Sociedad de Ginecotocología del Uruguay. Primer Consenso Uruguayo Sobre Síndromes Antifosfolipídicos del Embarazo. Montevideo: Aventis, 2002.
21) Greaves M, Control of Anticoagulation Subcommittee of the Scientific and Standarization Committee of the International Society of Thrombosis and Haemostasis. Limitations of the laboratory monitoring of heparin therapy. Scientific and Standarization Committee Communications: on behalf of the Control of Anticoagulation Subcommittee of the Scientific and Standarization Committee of the International Society of Thrombosis and Haemostasis. Thromb Haemost 2002, 87(1): 163-4.
22) Uchikova EH, Ledjev II. Changes in haemostasis during normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2005; 119(2): 185-8.
23) Holmes VA, Wallace JM. Haemostasis in normal pregnancy: a balancing act?. Biochem Soc Trans 2005; 33(Pt 2): 428-32.
24) Brenner B. Haemostatic changes in pregnancy. Thromb Res 2004; 114(5-6): 409-14.
25) Nolan TE, Smith RP, Devoe LD. Maternal plasma D-Dimer levels in normal and complicated pregnancies. Obstet Gynecol 1993; 81(2): 235-8.
26) Aharon A, Brenner B. Haemostatic mechanisms in human placenta. Best Pract Clin Haematol 2003; 16(2): 183-95.
27) O’Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17(3): 385.96.
28) Francalanci I, Comeglio P, Liotta AA, Cellai AP, Fedi S, Parretti E, et al. D-dimer concentrations during normal pregnancy, as measured by ELISA. Thromb Res 1995; 78(5): 399-405.
29) Kline JA, Williams GW, Hernandez-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005 May; 51(5): 825-9.
30) Chabloz P, Reber G, Boehlen F, Hohlfeld P, de Moerloose P. TAFI antigen and D-dimer levels during normal pregnancy and at delivery. Br J Haematol 2001; 115(1): 150-2.
2) Bick RL, Madden J, Heller KB. Recurrent miscarriage: causes, evaluation and treatment. Medscape Womens Health 1998; 3(3): 2.
3) Soulier J, Boffa MC. Avortements a repetition thromboses et anticoagulant circulant antithromboplastine: Trois observations. Nouv Press Med 1980; 9: 859.
4) Amout J. Antiphospholipid syndrome: diagnostic aspects of lupus anticoagulant. Thromb Haemost 2001; 86(1): 83-91.
5) Greer IA. The challenge of thrombophilia in maternal-fetal medicine. N Engl J Med 2000; 342(6): 424-5.
6) Rosove M, Tabsh B, Wasserstrum N, Howard P, Hahn B, Kalunian K. Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet Gynecol 1990; 75(4): 630-4.
7) Many A, Pauzner R, Carp H, Langevitz P, Martinowitz U. Treatment of patients with antiphospholipid antibodies during pregnancy. Am J Reprod Immunol 1992; 28(3-4): 216-8.
8) Kobayashi S, Tamura N, Tsuda H, Mokuno C, Hashimoto H, Hirose S. Immunoadsorbent plasmapheresis for a patient with antiphospholipid syndrome during pregnancy. Ann Rheum Dis 1992; 51(3): 399-401.
9) Otero AM, Pou Ferrari R, Dellepiane M, Muxi P, De Lisa E, Attarian D, et al. Pregnancy outcome in women with recurrent pregnant loss treated with enoxa-parine. Trombosis and Haemostasis. Suppl. July 2001. SIN 0340 – 6245).
10) Biasiutti FD, Strebel JK. Anticoagulation and antiaggrega-tion during pregnancy. Ther Umsch 2003; 60(1): 54-8.
11) Gebhardt GS, Hall DR. Inherited and acquired thrombophilias and poor pregnancy outcome: should we be treating with heparin?. Curr Opin Obstet Gynecol 2003;15(6): 501-6.
12) Gris JC, Mercier E, Quere I, Lavigne-Lissalde G, Cochery-Nouvellon E, Hoffet M, et al. Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood 2004;103(10): 3695-9.
13) Galli M, Barbui T. Antiphospholipid antibodies and pregnancy. Best Pract Clin Haematol 2003;16(2): 211-25.
14) Carp H, Dolitzky M, Inbal A. Thromboprophylaxis improves the live birth rate in women with consecutive recurrent miscarriages and hereditary thrombophilia. J Thromb Haemost 2003; 1(3): 433-8.
15) Alarcon-Segovia D, Boffa MC, Branch W, Cervera R, Gharavi A, Khamashta M, et al. Prophylaxis of the antiphospholipid syndrome: a consensus report. Lupus 2003; 12(7): 499-503.
16) Copplestone JA, Pavord S, Hunt BJ, The Obstetric Haematology Group of the British Society for Haematology. Anticoagulation in pregnancy: a survey of current practice. Br J Haematol 2004; 124(1): 124-5.
17) Otero AM, Pou Ferrari R, Pons E, Storch E, Alonso J, De Lisa E, et al. Enoxaparina y aspirina a bajas dosis en el tratamiento de los síndromes antifosfolipídicos del embarazo. Seguridad y utilidad. Arch Med Int 2005; 27(2-3): 41-5.
18) Alhenc-Gélas M, Jestin-Le Guernic C, Vitoux JF, Kher A, Aiach M, Fiessinger JM. Adjusted versus fixed doses of low molecular weight heparin fragmin in the treatment of deep venous thrombosis. Fragmin-Study Group. Thromb Haemost 1994; 71(6): 698-702.
19) Leizorovicz A, Bara L, Samama MM, Haugh MC. Factor Xa inhibition: correlation between the plasma levels of anti-Xa activity and occurrence of thrombosis and haemorrhage. Haemostasis 1993; 23 Suppl 1: 89-98.
20) Sociedad de Hematología del Uruguay, Sociedad de Ginecotocología del Uruguay. Primer Consenso Uruguayo Sobre Síndromes Antifosfolipídicos del Embarazo. Montevideo: Aventis, 2002.
21) Greaves M, Control of Anticoagulation Subcommittee of the Scientific and Standarization Committee of the International Society of Thrombosis and Haemostasis. Limitations of the laboratory monitoring of heparin therapy. Scientific and Standarization Committee Communications: on behalf of the Control of Anticoagulation Subcommittee of the Scientific and Standarization Committee of the International Society of Thrombosis and Haemostasis. Thromb Haemost 2002, 87(1): 163-4.
22) Uchikova EH, Ledjev II. Changes in haemostasis during normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2005; 119(2): 185-8.
23) Holmes VA, Wallace JM. Haemostasis in normal pregnancy: a balancing act?. Biochem Soc Trans 2005; 33(Pt 2): 428-32.
24) Brenner B. Haemostatic changes in pregnancy. Thromb Res 2004; 114(5-6): 409-14.
25) Nolan TE, Smith RP, Devoe LD. Maternal plasma D-Dimer levels in normal and complicated pregnancies. Obstet Gynecol 1993; 81(2): 235-8.
26) Aharon A, Brenner B. Haemostatic mechanisms in human placenta. Best Pract Clin Haematol 2003; 16(2): 183-95.
27) O’Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17(3): 385.96.
28) Francalanci I, Comeglio P, Liotta AA, Cellai AP, Fedi S, Parretti E, et al. D-dimer concentrations during normal pregnancy, as measured by ELISA. Thromb Res 1995; 78(5): 399-405.
29) Kline JA, Williams GW, Hernandez-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005 May; 51(5): 825-9.
30) Chabloz P, Reber G, Boehlen F, Hohlfeld P, de Moerloose P. TAFI antigen and D-dimer levels during normal pregnancy and at delivery. Br J Haematol 2001; 115(1): 150-2.
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Published
2006-03-31
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Otero AM, Lens D, Pons E, Pou Ferrari R, Attarian D, Motta N. D-dimer ELISA for biological control of low molecular weight heparin treatment during pregnancy. Rev. Méd. Urug. [Internet]. 2006 Mar. 31 [cited 2024 Sep. 7];22(1):52-8. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/784
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