Fibrinolytic proteins of normal pregnancy and pre-eclamptic patients in North West Nigeria

Abstract

BackgroundThe hypercoagulability of pregnancy is exaggerated in pre-eclamptic state because of endothelial activation with resultant production of some endothelial derived proteins that are said to be inhibitors of fibrinolysis. This study compares these proteins like tPA, PAI-1 and D-dimers in normal pregnant women and the pre-eclamptic women.MethodologyThis was a comparative cross-sectional study. Eighty-five pre-eclamptic women were recruited as subjects and eighty five age, trimester and parity matched normotensive pregnant women as controls. Levels of PT, aPTT, tPA, PAI-1, D-dimer protein were determined in blood samples of subjects and controls. Urinalysis was performed with dipstick method on their urine samples. Data generated was analysed using the IBM®SPSS 20.0 (2011) soft ware packages and the level of significance was a p-value <0.05.ResultsThe mean age of the respondents was 29.9±5.2 years. The median(25th–75th percentile) values of D-dimer, tPA, and PAI-1 of subjects were 730 (305.000–1560.000ng/ml), 0.11 (0.065–0,300ng/ml) and 3.65 (2.970–4,400ng/ml) respectively which were significantly higher than the corresponding values in the controls of 520 (24.000–1030.000ng/ml), 0.05 (0.040–0.090ng/ml and 2.650 (2.125–3.400ng/ml) respectively, p<0.05 each.ConclusionThe abnormal levels of PAI-1, D-dimer and tPA imply that they contribute to the exaggerated hypercoagulabilty state in pre-eclampsia thus, measuring their levels can help in the management of the condition.

Studies of Some Haemostatic Variables in Preeclamptic Women in Owerri, Imo State, Nigeria

“…D-dimer is increased in normal pregnancy because of compensated state of low grade intravascular coagulation; Moreover, this increase shows that, inspite of the marked impairment in fibrinolytic potential; the fibrinolytic system remains functionally active. Previous research showed higher d-dimer concentrations in pregnant women with preeclampsia compared with normotensive pregnant women [18] [31] [32]. D-dimer is involved in the dynamic balance between plasminogen activators (t-PA and uPA) and plasminogen inhibitor (PAI-1) in women with preeclampsia [33] therefore, d-dimer concentration can reflect the dynamic changes in both the super-hypercoagulable status and the activated fibrinolytic state in preeclamptic patients [34] [35] [36].…”

Association of D-dimers with acute kidney injury in pregnant women: a retrospective study

“… 4 , 10 , 17 Preeclampsia has been associated with a hypercoagulable state. 24 Thrombotic microangiopathy comprises thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome. Their common characteristics are occlusion of small arteries and capillaries and platelet aggregation.…”

Pathophysiology of the Venous Thromboembolism Risk in Preeclampsia

“…84,100 Other procoagulant factors such as coagulation FVIII andvWF as well as markers of coagulation activation (such as D-dimer levels) have also been reported to be more significantly increased in pregnancies affected by preeclampsia relative to thoseobserved in the setting of normal, healthy pregnancy. 101 The enhanced procoagulant activity observed in preeclampsia is further augmented by a marked impairment in endogenous anticoagulant pathways, with antithrombin, protein C and free protein S activity all reported to be lower among women with preeclampsia in comparison to thoseobserved among the healthy pregnant population. 102,103 Derangements in the fibrinolytic pathway, with increased activation of fibrinolysis but also with increased fibrin formation and increased plasminogen activator inhibitor-1 (PAI-1, an endogenous inhibitor of fibrinolysis) levels, have also been described in preeclampsia and appear to favour an even more marked impairment in fibrinolytic activity than that observed in healthy pregnancy.…”

“…102,103 Derangements in the fibrinolytic pathway, with increased activation of fibrinolysis but also with increased fibrin formation and increased plasminogen activator inhibitor-1 (PAI-1, an endogenous inhibitor of fibrinolysis) levels, have also been described in preeclampsia and appear to favour an even more marked impairment in fibrinolytic activity than that observed in healthy pregnancy. 101,104 Platelet Activity in Preeclampsia Platelets play a key role in physiological haemostasis by forming the initial 'platelet plug' at the site of vascular defects and by supporting thrombin generation by releasing various procoagulant substances following activation (such as vWF, factor V, fibrinogen, platelet factor-4, etc.). Platelets also support thrombin generation and fibrin formation through the expression of anionic phospholipids on their cell surface which act as co-factors for the procoagulant activity of the intrinsic andextrinsic tenase and prothrombinase complexes.…”