P60 Factor XIII Val34Leu polymorphism in patients surviving or not surviving ischemic stroke

3rd Women’s Health Issues in Thrombosis and Haemostasis P60 Factor XIII Val34Leu polymorphism in patients surviving or not surviving ischemic stroke A.H. Shemirani1 , B. Antalffy2 , E. Pongr´ acz3 , L. Muszbek1 . 1 Clinical Research Center, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary, 2 Department of Pathology, Di´ osgy˝ ori Vasgy´ ari Hospital, Miskolc, Hungary, 3 Department of Neurology, State Health Center, Budapest, Hungary Objectives: The results published on the association of FXIII-A Val34Leu polymorphism with the risk of ischemic stroke have been inconclusive. In these studies stroke survivors and nonsurvivors were not analyzed separately. Here, we investigated the effect of the polymorphism on the occurrence and the lethal outcome of ischemic stroke. Design and Methods: FXIII-A Val34Leu genotype of 508 patients who survived ischemic stroke (median age: 50) and 508 age- and sex-matched controls was determined using melting point analysis and FRET detection. DNA samples for genotyping were also isolated from tissue sections of 461 patients who died of ischemic stroke (mean age: 74) and the results were compared to a sex-matched population control group. Results: FXIII-A Val34Leu genotype had no effect on the risk of non-lethal stroke. Similarly, heterozygous Val34Leu polymorphism and Leu34 carriership did represent a significant risk of stroke with lethal outcome. However, homozygosity to Val34Leu polymorphism conferred a significant risk of lethal stroke to females (OR: 2.914, CI: 1.324 6.415); while in males the increase of the risk was not statistically significant (OR: 1.605, CI: 0.696 3.704). Conclusion: The homozygous form of FXIII-A Val34Leu polymorphism significantly increased the risk of stroke with lethal outcome in females. P61 Abnormal uterine bleeding and defects in system hemostasis R. Saidova, A. Makatsaria. Department of Obstetrics and Gynecology, Moscow Sechenov Medical Academy, Moscow, Russia Background: It is known that abnormal uterine bleeding (AUB) is the manifestation of various cases like leiomyoma (43.9%), adenomyosis (42 50%), bleeding in perimenopause due to the hyperplasia of endometrium (9.5 30.6%), endomethritisthe (41.9 99.2%). The uterine bleeding may also be seen in patients with hemorrhagic syndrome such as Von Willebrand Disease (50 70%), inherited forms of hemophilia (55 75%), thrombocytopatia and thrombocytopenia (70 80%). Material and Methods: Since 1985 up to 2008 we have observed more than 1,000 AUB patients of 12 to 55 years old. Disorders were detected via ultrasound, hormonal status and histopathological investigation. Functional tests for hemostasis were also performed. The disorders were divided into anovulatory and ovulatory states and hypo- and hyperoestrogen states. Results: Our examination showed that the most of patients of early reproductive age suffered from hypoestrogenic disorders, with 68.8% of cases being hypoestrogenic anovulation. In late reproductive age and in the perimenopausal period hyperoestrogenic types of disfunction were observed. 57.9% of women of late reproductive age and 87.5 % of perimenopausal period had hyperoestrogenic anovulation. Middle reproductive age proved to be the most stable period of reproductive system, with 71% of cases showing luteal phase disfunction. Von Willebrand Disease and syndrome were diagnosed in 25.3% and 12.8% of cases respectively, thrombocytopenia 7.3%, thrombocytopatia 48.7%, defects of the plasma coagulation factors 5.9%.

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Conclusion: In most cases of abnormalities of the reproductive system the hemorrhagic changes in hemostasis combined form of AUB was observed. P62 Thrombophilia and prosthetic valve thrombosis in pregnancy S.V. Akinshina, V.O. Bitsadze, V.B. Nemirovskiy, N.T. Meskhi, A.D. Makatsaria. Department of Obstetrics and Gynecology, I.M. Sechenov Moscow Medical Academy, Russia Aim: To determine genetic thrombophilia and antiphospholipid antibodies (APA) in pregnant women with prosthetic valve thrombosis. Material and Methods: We have examined 8 pregnant women (25.7 ± 3.5 years) with mechanical valve thrombosis (mitral valve n = 6, aortic valve n = 1, tricuspid valve n = 1). Analysis of thrombophilia and APA was performed in all patients. Results: History of obstetric complications (recurrent fetal loss, intrauterine growth restriction, preeclampsia, antenatal death) was observed in 3 women. Thromboembolic complications were observed in 4 women (stroke n = 2, renal and spleen thrombosis n = 1, iliofemoral thrombosis after cesarean section n = 1). Before the admission to our hospital (in 8 28 weeks of gestation) 5 patients received warfarin without regular LMWH in low doses. 1 patient did monitoring, 3 patients not receive any anticoagulants in pregnancy during 1 month. Fetal mortality was 50% (n = 4). One patient died due to pulmonary embolism 48 hours after the simultaneous cesarean section and valve replacement. Multigenic thrombophilia (8805; 4 mutations concomitantly) and APA were detected in 100%. MTHFR C677T, PAI-1 675 4G/5G, t-PA I/D, F Hageman 46C/T, fibrinogen 455G/A, FV Leiden, prothrombin G20210A were detected in 6, 6, 2, 2, 4, 2 and 2 cases respectively. Lupus anticoagulant, anti-beta-glycoprotein I, anticardiolipins, antiannexin V antibodies were detected in 3, 6, 2 and 3 patients respectively. Conclusion: Prosthetic valve thrombosis in pregnancy may be associated with hypercoagulation state and inadequate anticoagulation in women with multigenic thrombophilia and APA-circulation. P63 Pregnancy management in women with history of obsteric complications: did thrombophilia change our strategy? A.D. Makatsaria, V.O. Bitsadze, S.M. Baimuradova, S.V. Akinshina. Department of Obstetrics and Gynecology, I.M. Sechenov Moscow Medical academy, Russia Aims: To determine genetic thrombophilia and to evaluate maternal and fetal outcomes in women with history of pregnancy complications receiving the preconception treatment. Material and methods: During the last 7 years we examined a total of 800 patients with history of pregnancy complications: 400 patients with fetal loss syndrome, 160 patients with severe preeclampsia, 80 patients with venous thromboembolism (VTE), 100 patients with placental abruption, 60 women with antenatal death. All patients and 500 healthy controls were tested to have genetic thrombophilia and antiphospholipid antibodies. Women with history of pregnancy complications received treatment in the preconception period and during pregnancy: low molecular weight heparin (LMWH) guided by D-dimer, aspirin, antioxidants, vitamins of B group, folic acid (up to 4 mg in women with hyperhomocysteinemia). Results: Thrombophilia was found in 75% of the women with fetal loss syndrome and antenatal death, in 96% of the women with recurrent preeclampsia, in 70% of the women with history of 1 episode of preeclampsia, in 80% of the women with placental abruption and in 100% of the women with VTE. In the study group nobody had moderate or severe forms of preeclampsia. Mild preeclampsia was observed in