Clinical experience in the study of thrombodynamics in pregnant women at risk of developing preeclampsia and during its manifestation

Abstract

BACKGROUND: Need for early diagnosis of intravascular activation of coagulation in obstetric patients at risk of preeclampsia.

AIM: The aim of this study was to assess the diagnostic value of the thrombodynamics test in patients at risk of developing preeclampsia and during its manifestation.

MATERIALS AND METHODS: Dynamic thrombophotometry was performed in 56 pregnant women using a domestic “T2 Thrombodynamics Recorder” device (GemaKor Ltd., Russia). The first study group consisted of patients in the second to early third trimester of pregnancy (n = 45), who, due to hypercoagulability, according to the conventional coagulogram, received low-molecular-weight heparin therapy (calcium nadroparin 0.3 ml or enoxaparin sodium 0.4 ml subcutaneously). The thrombodynamics test was performed to evaluate the efficacy of anticoagulant therapy. The second study group involved patients with moderate (n = 11) and severe (n = 8) preeclampsia.

RESULTS: The test was effective in monitoring the state of the hemostasis system in pregnant women receiving anticoagulant therapy — despite normal coagulogram test parameters, the increased rate of fibrin clot formation and / or spontaneous clots indicated increased anticoagulant therapy in 37.8% of patients. Among patients with extragenital pathology, the incidence of spontaneous clots, which should not form during normal coagulation, was observed in all pregnant women with chronic arterial hypertension combined with obesity (χ² = 6.11; p < 0.02), which characterizes the tendency to activate intravascular coagulation in such patients. Subsequently, moderate PE developed in 15.6% of pregnant women with predisposing extragenital pathology, there being no cases of severe preeclampsia. A comparison of thrombodynamics test parameters in patients with moderate and severe preeclampsia showed that in severe preeclampsia, there is a tendency to a higher rate of fibrin clot formation and a higher frequency of spontaneous clot formation (χ² = 12.7; p < 0.01). The test demonstrated high sensitivity (81.8%) and specificity (97.4%) of signaling the presence of severe preeclampsia.

CONCLUSIONS: Demonstration of a clinical case of HELLP syndrome in a pregnant woman showed that confirmation of consumption thrombocytopenia due to activation of intravascular coagulation using the thrombodynamics test, in contrast to the global thromboelastography test and the conventional coagulogram test, allowed timely initiation of anticoagulant therapy and avoided the development of irreversible secondary microangiopathy.

Keywords

pregnancy / preeclampsia / thrombodynamics test / intravascular coagulation

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