- Email: [email protected]
P75 Monitoring thrombophilia markers in complicated pregnancy
3rd Women’s Health Issues in Thrombosis and Haemostasis Thrombocytopathy was diagnosed in 31.3% of women, and 13.3% of subjects presented with manifestations of von Willebrand’s disease: type 1 in 5 of them (62.5%), type 2A in 2 women (25%), and type 2B in 1 case (12.5%). No significant haemostatic impairments were found in 9.8% of subjects. Fifteen women evaluated prospectively received differentiated pathogenetic therapy and prophylaxis, according to the diagnosed condition. All women delivered live babies without any cases of obstetrical bleeding. Conclusion: The results of this study allow us to presume that baseline occult disorders in the haemostatic system may have a key role in the genesis of massive obstetrical blood loss. P75 Monitoring thrombophilia markers in complicated pregnancy N.V. Samburova, Z.K. Gadaeva, D.Ch. Kchizroeva. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia It is known that the complicated pregnancy is accompanied by hemostasis disturbances. Research objective: To define value definition of levels of markers of a thrombophilia (TAT, F1+2, D-dimer) in patients with a complicated pregnancy. Material and methods: We observed 32 pregnant women with gestosis. 62.5% of the patients had disturbances of an uteroplacental blood flow, 50.0% had an intrauterine growth retardation (IUGR). Levels TAT, F1+2, D-dimer were estimated by an immunoenzymatic method. Results: All patients with gestosis had high levels TAT, F1+2 and D-dimer. Values of markers of a thrombophilia were above in patients with a severe gestosis. D-dimer in pregnant women with a mild gestosis has averaged 2.4 mkg/ml, with a severe gestosis 2.9 mkg/ml. 2 patients with a severe gestosis had high levels of molecular markers of a thrombophilia and signs of a hypocoagulation according to thrombelastography. Patients without signs of a hypocoagulation and other contraindications have been treated by a low-molecular weight heparin (LMWH). In 2 weeks of therapy, positive dynamics have been noted in patients without IUGR and in 5 patients with IUGR. Patients with a hypocoagulation have been treated by a fresh frozen plasm (400.0 ml). Level of markers of a thrombophilia have been raised in all patients at the postnatal period. Conclusions: Definition of markers of a thrombophilia (TAT, F1+2, D-dimer) in patients with a complicated pregnancy allows us to define indications and contraindications to therapy LMWH and to supervise its efficiency. P76 Advances in understanding of DIC importance of early detection of background haemostatic disorders in development of advanced strategies of DIC treatment and prevention O. Panfilova, A. Makatsaria. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia Success in biology and medicine (discovery of the antiphospholipid syndrome (APS) and various genetic thrombophilias) and our experience (more than 1,000 patients with various obstetrical pathology, observed over the last 10 years in our department) have allowed to make a number of additions in understanding of DIC pathophysiology and contributed to the development of advanced strategies of DIC treatment and prevention. Background: diseases and disorders of hemostasis (hemorrhagic diathesis) bring to bear influence on the DIC progression. DIC is a systemic syndrome (occuring against thrombophylias, APS), being a part of pathogenesis of systemic inflammatory
S161
response syndrome (SIRS). Thrombophilic changes at the congenital and acquired disorders of hemostasis underlie the majority of the complications leading to loss of pregnancy and development of gestosis. Development of gestosis accompanied by chronic forms of DIC, in 80 percent of cases occurs against thrombophilias, especially genetical, and also against acquired defects of a hemostasis (APS). 59% of patients with gestosis have isolated genetic defects of a hemostasis, 10% APS and genetical thrombophilias combination. Abruptio placentae accompanied by acute forms of DIC is characterised by the genetic defects of hemostasis in 80 90 percent of cases. Thus, if genetical or acquired thrombophilias are in evidence besides the ordinary DIC triggers in obstetrics, the prognosis is much more negativ, risk of thrombogemorragic complications is close to 100%. Thrombophilias and obstetrical complications in the anamnesis have induced us to administrate anticoagulants and antioxidants from early pregnancy to prevent recurrent complications of pregnancy accompanied by DIC. P77 Profylaxis of DIC and thrombophilia during chemotherapy in gynecologic cancer patients A. Makatsaria, A. Vorobiev. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia Background: Chemotherapy contributes a significant risk of VTE and hemorrhage complications in cancer patients, especially with widespread malignant process. Chemotherapy stipulates for endothelium damage, direct platelet activation and reduction of fibrinolytic activity. Methods: 116 patients with ovarian cancer undergoing chemotherapy were divided to 2 groups: 56 received Dalteparin 0.3 ml (LMWH) before each chemotherapy course and 60 did not receive any anticoagulant profilaxis during chemotherapy. Laboratory tests: Platelet aggregation tests with different stimulators: Adrenaline, Ristocetin and ADP in various concentrations, platelet factor 4 (PF4). DIC and thrombophilia marker tests: D-dimer, TAT complexes, F1+2 prothrombin fragments. Fibrinolytic activity tests: determine PAI level, Protein C and S levels. Results: We have detected the sign of thrombofilia and DIC in more than 90% of the patients during chemotherapy. We detected a slight reduction in the levels of thrombophilia markers. However, damage of fibrinolytic activity was observed, due to iatrogenic effects of chemotherapy: reduction in proteins C and S levels, increase PAI concentration, platelets hyperaggregation in ristotetin presence. In patients who received LMWH normalization of lab test results was detected during 2 3 days after the chemotherapy course. In comparison with the control group, normalisation was in 5 7 days in 22% and in 7 12 day in 58%, in 20% spontaneous normalisation was not registered. Conclusions: Due to endothelium protection activity, LMWH in gynecologic cancer patients during chemotherapy, significantly reduces intensity of thrombofilia and DIC. P78 Thrombophilia, gynecologic cancer and thrombosis A. Vorobiev. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia Background: Patients with gynecologic cancer represent the highest risk group of thrombohemorrhage complications, especially in operation period, and also during chemotherapy. Aim: To determine necessary range of laboratory tests for a high-grade estimation of haemostasis state in cancer patients. Methods: Since 2000 546 patients with gynecologic cancer were examined: ovarian cancer, uterine carcinoma, cervical carcinoma, vaginal and vulva cancer undergoing operation,
S161
response syndrome (SIRS). Thrombophilic changes at the congenital and acquired disorders of hemostasis underlie the majority of the complications leading to loss of pregnancy and development of gestosis. Development of gestosis accompanied by chronic forms of DIC, in 80 percent of cases occurs against thrombophilias, especially genetical, and also against acquired defects of a hemostasis (APS). 59% of patients with gestosis have isolated genetic defects of a hemostasis, 10% APS and genetical thrombophilias combination. Abruptio placentae accompanied by acute forms of DIC is characterised by the genetic defects of hemostasis in 80 90 percent of cases. Thus, if genetical or acquired thrombophilias are in evidence besides the ordinary DIC triggers in obstetrics, the prognosis is much more negativ, risk of thrombogemorragic complications is close to 100%. Thrombophilias and obstetrical complications in the anamnesis have induced us to administrate anticoagulants and antioxidants from early pregnancy to prevent recurrent complications of pregnancy accompanied by DIC. P77 Profylaxis of DIC and thrombophilia during chemotherapy in gynecologic cancer patients A. Makatsaria, A. Vorobiev. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia Background: Chemotherapy contributes a significant risk of VTE and hemorrhage complications in cancer patients, especially with widespread malignant process. Chemotherapy stipulates for endothelium damage, direct platelet activation and reduction of fibrinolytic activity. Methods: 116 patients with ovarian cancer undergoing chemotherapy were divided to 2 groups: 56 received Dalteparin 0.3 ml (LMWH) before each chemotherapy course and 60 did not receive any anticoagulant profilaxis during chemotherapy. Laboratory tests: Platelet aggregation tests with different stimulators: Adrenaline, Ristocetin and ADP in various concentrations, platelet factor 4 (PF4). DIC and thrombophilia marker tests: D-dimer, TAT complexes, F1+2 prothrombin fragments. Fibrinolytic activity tests: determine PAI level, Protein C and S levels. Results: We have detected the sign of thrombofilia and DIC in more than 90% of the patients during chemotherapy. We detected a slight reduction in the levels of thrombophilia markers. However, damage of fibrinolytic activity was observed, due to iatrogenic effects of chemotherapy: reduction in proteins C and S levels, increase PAI concentration, platelets hyperaggregation in ristotetin presence. In patients who received LMWH normalization of lab test results was detected during 2 3 days after the chemotherapy course. In comparison with the control group, normalisation was in 5 7 days in 22% and in 7 12 day in 58%, in 20% spontaneous normalisation was not registered. Conclusions: Due to endothelium protection activity, LMWH in gynecologic cancer patients during chemotherapy, significantly reduces intensity of thrombofilia and DIC. P78 Thrombophilia, gynecologic cancer and thrombosis A. Vorobiev. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia Background: Patients with gynecologic cancer represent the highest risk group of thrombohemorrhage complications, especially in operation period, and also during chemotherapy. Aim: To determine necessary range of laboratory tests for a high-grade estimation of haemostasis state in cancer patients. Methods: Since 2000 546 patients with gynecologic cancer were examined: ovarian cancer, uterine carcinoma, cervical carcinoma, vaginal and vulva cancer undergoing operation,