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Thromb Haemost 2009; 101(04): 755-761
DOI: 10.1160/TH08-06-0386
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Coagulation assessment by rotation thrombelastometry in normal pregnancy

Cyril Huissoud
1   Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France
2   INSERM U846, Stem Cell and Brain Research Institute, Bron, Université de Lyon 1, UMR-S 846, Lyon, France
,
Nicolas Carrabin
1   Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France
,
Mehdi Benchaib
3   Human Assisted Reproduction Laboratory, Hôpital Femme-Mère-Enfant, Bron Cedex, France
4   Claude Bernard University, University of Lyon, University Lyon 1, France
,
Oriane Fontaine
5   Intensive Care and EMS, Edouard Herriot University Hospital, Hospices civils de Lyon, Lyon, France
,
Albrice Levrat
5   Intensive Care and EMS, Edouard Herriot University Hospital, Hospices civils de Lyon, Lyon, France
,
Denis Massignon
6   Haemostasis Laboratory, University Hospital Lyon-Sud, Hospices civils de Lyon, France
,
Sandrine Touzet
4   Claude Bernard University, University of Lyon, University Lyon 1, France
6   Haemostasis Laboratory, University Hospital Lyon-Sud, Hospices civils de Lyon, France
7   Epidemiology, Professional Practices and Healthcare Networks Study Unit, Hospices Civils de Lyon, Pole IMER, Lyon, France
,
René-Charles Rudigoz
1   Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France
4   Claude Bernard University, University of Lyon, University Lyon 1, France
,
Michel Berland
4   Claude Bernard University, University of Lyon, University Lyon 1, France
8   Department of Obstetrics and Gynecology, University Hospital Lyon-Sud, Hospices civils de Lyon, France
› Author Affiliations
Further Information

Publication History

Received: 18 June 2008

Accepted after major revision: 10 January 2009

Publication Date:
23 November 2017 (online)

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Summary

We analysed changes in coagulation during normal pregnancy with a novel point-of-care device based on thrombelastometry (ROTEM®). We compared the results obtained with those of standard coagulation tests in 104 patients: 20 non-pregnant women (controls) and 84 women in the first (T1, n=17), second (T2, n=9) and third (T3, n=58) trimesters of pregnancy. We measured the clotting time (CT), the maximum clot firmness (MCF), the early clot amplitude at 5 and 15 minutes (CA5, CA15) and the clot lysis index (CLI30) with four tests containing specific reagents. (a) The INTEM® test involving ellagic acid activated the intrinsic pathway and (b) the EXTEM® test using tissue factor triggered the extrinsic pathway; (c) The FIBTEM® test based on a platelet inhibitor (cytochalasin D) evaluated the contribution of fibrinogen to clot formation and (d) the APTEM® test was similar to the EXTEM but was based on inhibition in vitro of fibrinolysis by aprotinin. CT and CLI30 were not significantly modified during pregnancy whereas MCF, CA5 and CA15 (INTEM, EXTEM, FIBTEM) increased significantly between the second and third trimesters (e.g. median [interquartile range]: MCF-FIBTEM, 13 [11–16] mm vs. 19 [17–23] mm, respectively, in controls and T3, p< 0.001). EXTEM values were not significantly different from those measured with APTEM. There were significant correlations between the results obtained with ROTEM and those from standard coagulation tests. ROTEM analysis showed a marked increase in coagulability during normal pregnancy. ROTEM values may serve as the basis for future studies in pregnant women.

Keywords

Thrombelastometry - thrombelastography - pregnancy - hyper-coagulability
 

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