Effect of Reduced INR in Early Pregnancy on the Occurrence of Preeclampsia: A Retrospective Cohort Study

Overview

Journal Clin Appl Thromb Hemost

Publisher Sage Publications

Specialty Cardiology & Vascular Diseases

Date 2024 Mar 26

PMID 38529627

Authors

Pei-Pei Jin

Ning Ding

Jing Dai

Xiao-Yan Liu

Pei-Min Mao

Affiliations

Soon will be listed here.

Abstract

To investigate the effect of reduced early-pregnancy activated partial thrombin time (APTT), prothrombin time (PT), and international standardized ratio (INR) on the risk of preeclampsia. A total of 8549 pregnant women with singleton births were included. Early pregnancy APTT, PT, and INR levels, with age, birth, prepregnancy body mass index, fibrinogen (FBG), thrombin time (TT), D-dimer (DD2), antithrombin III (ATIII), fibrin degradation products (FDP) as confounders, generalized linear model of APTT, the relative risk of PT and INR when INR reduction. After adequate adjustment for confounders, the relative risk of preeclampsia was 0.703 for every 1 s increase in plasma PT results in early pregnancy, and for every 0.1 increase in plasma INR results, the relative risk of preeclampsia was 0.767. With a PT less than the P25 quantile (<11 s), the relative risk of preeclampsia was 1.328. The relative risk of preeclampsia at an INR less than the P25 quantile (<0.92) was 1.24. There was no statistical association between APTT on the risk of preeclampsia. The relative risk of preeclampsia is strongly associated with a decrease in PT and INR in early pregnancy. PT and INR in early pregnancy were a potential marker in the risk stratification of preeclampsia. Focusing on reduced PT and INR levels in early pregnancy can help to identify early pregnancies at risk for preeclampsia.

References

Kohli S, Ranjan S, Hoffmann J, Kashif M, Daniel E, Al-Dabet M . Maternal extracellular vesicles and platelets promote preeclampsia via inflammasome activation in trophoblasts. Blood. 2016; 128(17):2153-2164. DOI: 10.1182/blood-2016-03-705434. View

Kim M, Han G, Kwon J, Kim Y . Clinical significance of platelet-to-lymphocyte ratio in women with preeclampsia. Am J Reprod Immunol. 2018; 80(1):e12973. DOI: 10.1111/aji.12973. View

Han L, Liu X, Li H, Zou J, Yang Z, Han J . Blood coagulation parameters and platelet indices: changes in normal and preeclamptic pregnancies and predictive values for preeclampsia. PLoS One. 2014; 9(12):e114488. PMC: 4252147. DOI: 10.1371/journal.pone.0114488. View

Armaly Z, Jadaon J, Jabbour A, Abassi Z . Preeclampsia: Novel Mechanisms and Potential Therapeutic Approaches. Front Physiol. 2018; 9:973. PMC: 6068263. DOI: 10.3389/fphys.2018.00973. View

. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2005; 99(1):159-67. DOI: 10.1016/s0029-7844(01)01747-1. View

Wang Y, Nie G . High levels of HtrA4 observed in preeclamptic circulation drastically alter endothelial gene expression and induce inflammation in human umbilical vein endothelial cells. Placenta. 2016; 47:46-55. PMC: 5090051. DOI: 10.1016/j.placenta.2016.09.003. View

Dusse L, Carvalho M, Cooper A, Lwaleed B . Tissue factor and tissue factor pathway inhibitor: a potential role in pregnancy and obstetric vascular complications?. Clin Chim Acta. 2006; 372(1-2):43-6. DOI: 10.1016/j.cca.2006.03.025. View

Redman C, Sargent I . Placental stress and pre-eclampsia: a revised view. Placenta. 2009; 30 Suppl A:S38-42. DOI: 10.1016/j.placenta.2008.11.021. View

Heilmann L, Rath W, Pollow K . Fetal hemorheology in normal pregnancy and severe preeclampsia. Clin Hemorheol Microcirc. 2005; 32(3):183-90. View

10.

Askie L, Duley L, Henderson-Smart D, Stewart L . Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet. 2007; 369(9575):1791-1798. DOI: 10.1016/S0140-6736(07)60712-0. View

11.

Sibai B, Dekker G, Kupferminc M . Pre-eclampsia. Lancet. 2005; 365(9461):785-99. DOI: 10.1016/S0140-6736(05)17987-2. View

12.

Williams V, Griffiths A, Carbone S, Hague W . Fibrinogen concentration and factor VIII activity in women with preeclampsia. Hypertens Pregnancy. 2007; 26(4):415-21. DOI: 10.1080/10641950701548240. View

13.

Say L, Chou D, Gemmill A, Tuncalp O, Moller A, Daniels J . Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2(6):e323-33. DOI: 10.1016/S2214-109X(14)70227-X. View

14.

Kline J, Williams G, Hernandez-Nino J . D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem. 2005; 51(5):825-9. DOI: 10.1373/clinchem.2004.044883. View

15.

Liu Y, Ma Y . Promoter Methylation Status of WNT2 in Placenta from Patients with Preeclampsia. Med Sci Monit. 2017; 23:5294-5301. PMC: 5687122. DOI: 10.12659/msm.903602. View

16.

Conde-Agudelo A, Villar J, Lindheimer M . World Health Organization systematic review of screening tests for preeclampsia. Obstet Gynecol. 2004; 104(6):1367-91. DOI: 10.1097/01.AOG.0000147599.47713.5d. View

17.

Oladosu-Olayiwola O, Olawumi H, Babatunde A, Ijaiya M, Durotoye I, Biliaminu S . Fibrinolytic proteins of normal pregnancy and pre-eclamptic patients in North West Nigeria. Afr Health Sci. 2019; 18(3):576-583. PMC: 6307030. DOI: 10.4314/ahs.v18i3.15. View

18.

Ahlawat S, Pati H, Bhatla N, Fatima L, Mittal S . Plasma platelet aggregating factor and platelet aggregation studies in pre-eclampsia. Acta Obstet Gynecol Scand. 1996; 75(5):428-31. DOI: 10.3109/00016349609033348. View

19.

Zezza L, Ralli E, Conti E, Passerini J, Autore C, Caserta D . Hypertension in pregnancy: the most recent findings in pathophysiology, diagnosis and therapy. Minerva Ginecol. 2014; 66(1):103-26. View

20.

Shah D . Preeclampsia: new insights. Curr Opin Nephrol Hypertens. 2007; 16(3):213-20. DOI: 10.1097/MNH.0b013e3280d942e9. View