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P7 Microparticles from women with gestational vascular complications (GVC) induce cells apoptosis and impaired tube formation
3rd Women’s Health Issues in Thrombosis and Haemostasis by using implantation of temporary cava filter during the pregnancy. Method: The investigation included 89 women with pregnancy aged 19 36, with deep venous floating thrombus. The blood of all patients was analyzed for 6 genes of hemostasic system: factor I (fibrinogen), factor V (Leiden), prothrombin 20210A, methylenetetrahydrofolate reductase (MTHFR), PAI-1 (4G-5G), platelet receptor of fibrinogen. Results: Linear interrelation was revealed between deep venous floating thrombus and frequency of genetic polymorphism gene PAI-1 (p = 0.02). Fibrinogen G/F 455 genetic polymorphism in homozygous position (A/A) and PAI-1 genetic polymorphism genotype are the most significant of deep venous floating thrombus (p < 0.007, p = 0.036, accordingly). The results showed patients with PAI-1 genetic polymorphism in homozygous position 4G/4G that have been patients with deep venous floating thrombus (p = 0.02) and with revealed higher frequency of PTE (p = 0.05). The results were analyzed with SPSS for Windows 13.0. Data were represented as M±S.D. One-way ANOVA was used. Significance of differences was determined by nonparametric tests Mann Whitney, Fridman. Conclusions: The methods used for the purpose of highly efficient prevention of massive pulmonary embolism during the pregnancy revealed positive correlation between deep venous floating thrombus and frequency of genetic polymorphism gene PAI-1 (r = 0.34, p = 0.02). We could find a relationship between frequency of genetic polymorphism gene PAI-1 and gene fibrinogen G/F 455 and deep venous floating thrombus (r = 0.36, p = 0.036). P7 Microparticles from women with gestational vascular complications (GVC) induce cells apoptosis and impaired tube formation E. Shomer-Prital1 , S. Katzenell1 , B. Brenner1,2 , A. Aharon1,2 . 1 The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, 2 Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Israel Gestational vascular complications (GVC), such as preeclampsia and pregnancy induced hypertension, are associated with increased coagulability and elevated levels of microparticles (MPs). MPs’ role in GVC may be related to their effect on endothelial and placental trophoblast cells function. Our research has focused on the effect of MPs obtained from non-pregnant women (NPW), healthy pregnancies (HP) and women with GVC, on endothelial and trophoblast cells. We found that MPs from GVC induce 2-fold apoptosis in human umbilical vein endothelial cells (HUVEC) and trophoblast cells, compared to MPs from healthy pregnant women, as measured by TUNEL assay. Time-laps microscopy demonstrated that MPs affect cell angiogenesis as measured by tube formation assay. During the first 2 hours on matrigel, HUVEC cells create tubes, which disintegrate over time, with a 50% decrease at 4 hours and total disappearance after 10 hours. Added MPs maintain the tubes and reduce their collapse. HP MPs had the most significant angiogenic effect, with added HP MPs resulting in 18% decrease in tubes after 4 hours, while MPs from GVC decreased tubes by 30%. Furthermore, GVC MPs express lower levels of vascular endothelial growth factor than those of HP MPs (measured by ELISA). We found that MPs act as apoptotic as well angiogenic agents. In normal pregnancy, MPs’ apoptotic effect is low and angiogenesis is maintained, while in GVC, MPs induce apoptosis and disrupt angiogenesis. These findings demonstrate MPs’ role in maintaining healthy gestation, in contrast with vascular complications of pregnancy.
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P8 Corpus luteum hemorrhage in women with bleeding disorders R. Hoffman, B. Brenner. Rambam Health Care Campus, Thrombosis & Haemostasis Unit, POB 9602, Haifa, Israel Spontaneous bleeding during ovulation into corpus luteum in healthy women is usually a minor event and generally is of no clinical significance or sequella. Characteristically, hemorrhage occurs during midmenstrual cycle subsequent to the vascularization phase following ovulation. The other mechanism for CLH is when the ovum is extruded from the graafian follicle to form the corpus luteum. While rupture of corpus luteum may go unnoticed in healthy women it may lead to life threatening intraperitoneal hemorrhage in women with congenital or acquired bleeding disorders. Corpus luteum hemorrhage should always be suspected whenever a premenopauseal woman has an acute lower abdominal pain at her midcycle with negative pregnancy test, new onset anemia and a personal or family history of congenital bleeding disorders or in women on AC treatment. Thus, women who are at increased risk for CLH can be divided in two categories: A. Women taking anticoagulant because of thrombotic disorders. B. Women with congenital or acquired bleeding disorders. In our center, during the years 1996 2008 we have encountered six women with eleven episodes of CLH in total. Four women were treated with AC (LMWH included), because of inherited thrombophilia and antiphospholipid syndrome. The treatment of these women was conservative in most bleeding episodes and included supportive care with factor concentrates or reversal of warfarin effect. Oral contraceptives were administered in the women with bleeding disorders. In conclusion: as CLH is a potential life threatening bleeding event in premenopausal women, with an acquired or congenital bleeding disorders, we have to define the exact incidence of the problem and to determine the optimum management in the setting of an acute event and modes of prevention. In order to gather information about cases of CLH, we have suggested an International Registry. This suggestion has been presented at the SCC meeting which was held in Vienna on July 2008, in the subcommittee of Women Health Issues and this Registry will be soon available at the ISTH website. P9 Near patient international normalized ratio reliability in obstetrics A.S. Ducloy-Bouthors, F. Wierre, C. Barre-Drouard, A. Bauters, C. Nobecourt, R. Boodhun, A. Tournoys, B. Wibaut, B. Jude. Maternit´ e Jeanne de Flandre, Centre de biologie pathologie CHRU Lille, France Post-partum haemorrhage (PPH) remains a major cause of maternal morbidity and mortality related to childbirth; Charbit et al. [1] have shown that the decrease of fibrinogen is an early predictor of the severity of PPH. We hypothesized that INR measurement provided by CoaguChek Xs Plus® (ROCHE), a near-patient test of hemostasis, could a be a simple way to detect hemostatic alterations in the early stage of PPH, such as the INR measurement in end stage liver disease for outcome prediction in patients with decompensated cirrhosis. The aim of the prospective observational study was to verify the reliability of the near-patient versus laboratory test INR in obstetrics. After informed consent, 30 patients with non haemorrhagic post-partum and 12 HPP were enrolled for a laboratory test and CoaguChek XS INR 30 minutes after delivery. For the 42 pairs of measures, the correlation between the two methods was 0.96 with a 0.007 unit INR bias. In the non haemorrhagic group, the correlation was 0.98 with a 0.006 unit
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P8 Corpus luteum hemorrhage in women with bleeding disorders R. Hoffman, B. Brenner. Rambam Health Care Campus, Thrombosis & Haemostasis Unit, POB 9602, Haifa, Israel Spontaneous bleeding during ovulation into corpus luteum in healthy women is usually a minor event and generally is of no clinical significance or sequella. Characteristically, hemorrhage occurs during midmenstrual cycle subsequent to the vascularization phase following ovulation. The other mechanism for CLH is when the ovum is extruded from the graafian follicle to form the corpus luteum. While rupture of corpus luteum may go unnoticed in healthy women it may lead to life threatening intraperitoneal hemorrhage in women with congenital or acquired bleeding disorders. Corpus luteum hemorrhage should always be suspected whenever a premenopauseal woman has an acute lower abdominal pain at her midcycle with negative pregnancy test, new onset anemia and a personal or family history of congenital bleeding disorders or in women on AC treatment. Thus, women who are at increased risk for CLH can be divided in two categories: A. Women taking anticoagulant because of thrombotic disorders. B. Women with congenital or acquired bleeding disorders. In our center, during the years 1996 2008 we have encountered six women with eleven episodes of CLH in total. Four women were treated with AC (LMWH included), because of inherited thrombophilia and antiphospholipid syndrome. The treatment of these women was conservative in most bleeding episodes and included supportive care with factor concentrates or reversal of warfarin effect. Oral contraceptives were administered in the women with bleeding disorders. In conclusion: as CLH is a potential life threatening bleeding event in premenopausal women, with an acquired or congenital bleeding disorders, we have to define the exact incidence of the problem and to determine the optimum management in the setting of an acute event and modes of prevention. In order to gather information about cases of CLH, we have suggested an International Registry. This suggestion has been presented at the SCC meeting which was held in Vienna on July 2008, in the subcommittee of Women Health Issues and this Registry will be soon available at the ISTH website. P9 Near patient international normalized ratio reliability in obstetrics A.S. Ducloy-Bouthors, F. Wierre, C. Barre-Drouard, A. Bauters, C. Nobecourt, R. Boodhun, A. Tournoys, B. Wibaut, B. Jude. Maternit´ e Jeanne de Flandre, Centre de biologie pathologie CHRU Lille, France Post-partum haemorrhage (PPH) remains a major cause of maternal morbidity and mortality related to childbirth; Charbit et al. [1] have shown that the decrease of fibrinogen is an early predictor of the severity of PPH. We hypothesized that INR measurement provided by CoaguChek Xs Plus® (ROCHE), a near-patient test of hemostasis, could a be a simple way to detect hemostatic alterations in the early stage of PPH, such as the INR measurement in end stage liver disease for outcome prediction in patients with decompensated cirrhosis. The aim of the prospective observational study was to verify the reliability of the near-patient versus laboratory test INR in obstetrics. After informed consent, 30 patients with non haemorrhagic post-partum and 12 HPP were enrolled for a laboratory test and CoaguChek XS INR 30 minutes after delivery. For the 42 pairs of measures, the correlation between the two methods was 0.96 with a 0.007 unit INR bias. In the non haemorrhagic group, the correlation was 0.98 with a 0.006 unit