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Hamostaseologie 2020; 40(05): 594-604
DOI: 10.1055/a-1162-3905
Review Article

Pathophysiology of the Venous Thromboembolism Risk in Preeclampsia

Sarah Kelliher
1   Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
2   Irish Network for VTE Research (INViTE), Dublin, Ireland
,
Patricia B. Maguire
2   Irish Network for VTE Research (INViTE), Dublin, Ireland
3   UCD Conway SPHERE Research Group, Dublin, Ireland
4   School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
,
Paulina B. Szklanna
3   UCD Conway SPHERE Research Group, Dublin, Ireland
4   School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
,
Luisa Weiss
3   UCD Conway SPHERE Research Group, Dublin, Ireland
4   School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
,
Karl Ewins
1   Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
2   Irish Network for VTE Research (INViTE), Dublin, Ireland
5   Department of Haematology, Rotunda Hospital, Dublin, Ireland
,
Roseann O'Doherty
1   Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
,
Daniel Angelov
1   Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
,
Fionnuala Ní Áinle
1   Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
2   Irish Network for VTE Research (INViTE), Dublin, Ireland
3   UCD Conway SPHERE Research Group, Dublin, Ireland
5   Department of Haematology, Rotunda Hospital, Dublin, Ireland
6   School of Medicine, University College Dublin (UCD), Dublin, Ireland
,
Barry Kevane
1   Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
2   Irish Network for VTE Research (INViTE), Dublin, Ireland
3   UCD Conway SPHERE Research Group, Dublin, Ireland
6   School of Medicine, University College Dublin (UCD), Dublin, Ireland
› Author Affiliations Funding This study was funded by the Health Research Board of Ireland (R1379).
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Abstract

Preeclampsia complicates up to 8% of pregnancies and is a leading cause of fetomaternal morbidity andmortality. Treatment options are limited, with supportive care and delivery of the placenta representing the cornerstone of current management strategies. Derangements in blood coagulation are wellrecognised in this disorder and appear to favour an increased risk of venous thromboembolism among affected women. This risk appears to be most significant in the postpartum period. The mechanisms underlying this increased thrombosis risk remain to be fully elucidated although increased expression of procoagulant factors, endothelial dysfunction, attenuation of endogenous anticoagulant activity and increased platelet activity have been implicated in the prothrombotic tendency. Preeclampsia is also occasionally complicated by life-threatening haemorrhagic events and current evidence suggests that in some severe manifestations of this disease a coagulopathy with a clinical bleeding tendency may be the predominant haemostatic abnormality. Identifying affected women at significant risk of thrombosis and managing the competing thrombotic and haemorrhagic risks continue to be a significant clinical challenge. Derangements in blood coagulation are also implicated in the pathogenesis of preeclampsia; however, the role of antiplatelet or anticoagulant drugs in the prevention and treatment of this disorder remains a source of considerable debate. In addition, the potential role of specific haemostatic markers as diagnostic or screening tools for preeclampsia has also yet to be determined. Further characterisation of the underlying molecular mechanisms would likely be of major translational relevance and could provide insights into the pathogenesis of this disease as well as the associated haemostatic dysfunction.

Keywords

thrombosis - pregnancy - haemostasis


Publication History

Received: 20 December 2019

Accepted: 02 April 2020

Article published online:
25 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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