Gordon Haire1, Karl Egan1, Kiran Parmar2, Tom McKinnon2, Cathy Monteith3, Hugh O'Connor3, Barry Kevane4, Patricia Maguire5, Paulina B Szklanna6, Marie Galligan7, Jennifer C Donnelly3, Seamus Allen8, Naomi McCallion3, Beverley Hunt2, Fionnuala Ní Áinle9. 1. Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland; SPHERE Research Group, Conway Institute, University College Dublin, Ireland. 2. Department of Thrombosis & Haemostasis, King's College, London, United Kingdom. 3. The Rotunda Hospital, Parnell Square, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland. 4. Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland; SPHERE Research Group, Conway Institute, University College Dublin, Ireland; School of Biomolecular and Biomedical Sciences, University College Dublin, Ireland. 5. SPHERE Research Group, Conway Institute, University College Dublin, Ireland; Clinical Research Centre, Mater Misericordiae University Hospital, Dublin, Ireland; Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland. 6. SPHERE Research Group, Conway Institute, University College Dublin, Ireland; Clinical Research Centre, Mater Misericordiae University Hospital, Dublin, Ireland. 7. Clinical Research Centre, Mater Misericordiae University Hospital, Dublin, Ireland. 8. Royal College of Surgeons in Ireland, Dublin, Ireland. 9. Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland; SPHERE Research Group, Conway Institute, University College Dublin, Ireland; The Rotunda Hospital, Parnell Square, Dublin, Ireland; Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Medicine, University College Dublin, Ireland. Electronic address: fniainle@mater.ie.
Abstract
OBJECTIVE: ; Early-onset preeclampsia is a rare pregnancy-specific disorder associated with significantly increased maternal and fetal morbidity and mortality. Whilst it is known that even normotensive pregnancies are associated with changes in clot formation and dissolution, the nature of how these changes differ in those with early onset preeclampsia has not been well established. We sought to evaluate parameters of fibrin formation and fibrinolysis in individuals with early onset preeclampsia in comparison to both pregnant and non-pregnant controls. Furthermore, such parameters were correlated with markers of disease severity in this patient cohort, including the presence of multiorgan involvement, the rate of disease progression and the extent of the anti-angiogenic state in this condition. STUDY DESIGN: ; Patients with early onset preeclampsia (N = 20) and both pregnant (N = 16) and non -pregnant (N = 16) controls were recruited from the cohort at a large urban maternity hospital which saw over 15,000 deliveries during the study period. Platelet poor plasma was prepared from collected whole blood and analysed for parameters of fibrin formation and fibrinolysis (lagtime to and rate of fibrin formation; PAI-1; PAI-2; D-dimer; plasmin-antiplasmin; tPA) in addition to markers of angiogenesis (sFLT-1; Endoglin) using commercially available specific immunoassays. RESULTS: ; The maximum rate of fibrin formation as well as PAI-1, PAI-2 and D-dimer levels were all significantly increased in those with early onset preeclampsia and pregnant controls when compared to non-pregnant controls without significant differences between the 2 former groups. Plasmin-antiplasmin levels were significantly reduced in a similar manner. tPA levels were significantly elevated in EOP compared to both pregnant and non-pregnant controls. EOP was associated with significantly increased anti-angiogenic factors (sFLT-1; Endoglin) when compared to both pregnant and non-pregnant controls. CONCLUSION: ; Markers of fibrin formation and fibrinolysis are significantly alerted in early onset preeclampsia; furthermore, certain markers correlate with disease severity in this patient cohort.
OBJECTIVE: ; Early-onset preeclampsia is a rare pregnancy-specific disorder associated with significantly increased maternal and fetal morbidity and mortality. Whilst it is known that even normotensive pregnancies are associated with changes in clot formation and dissolution, the nature of how these changes differ in those with early onset preeclampsia has not been well established. We sought to evaluate parameters of fibrin formation and fibrinolysis in individuals with early onset preeclampsia in comparison to both pregnant and non-pregnant controls. Furthermore, such parameters were correlated with markers of disease severity in this patient cohort, including the presence of multiorgan involvement, the rate of disease progression and the extent of the anti-angiogenic state in this condition. STUDY DESIGN: ; Patients with early onset preeclampsia (N = 20) and both pregnant (N = 16) and non -pregnant (N = 16) controls were recruited from the cohort at a large urban maternity hospital which saw over 15,000 deliveries during the study period. Platelet poor plasma was prepared from collected whole blood and analysed for parameters of fibrin formation and fibrinolysis (lagtime to and rate of fibrin formation; PAI-1; PAI-2; D-dimer; plasmin-antiplasmin; tPA) in addition to markers of angiogenesis (sFLT-1; Endoglin) using commercially available specific immunoassays. RESULTS: ; The maximum rate of fibrin formation as well as PAI-1, PAI-2 and D-dimer levels were all significantly increased in those with early onset preeclampsia and pregnant controls when compared to non-pregnant controls without significant differences between the 2 former groups. Plasmin-antiplasmin levels were significantly reduced in a similar manner. tPA levels were significantly elevated in EOP compared to both pregnant and non-pregnant controls. EOP was associated with significantly increased anti-angiogenic factors (sFLT-1; Endoglin) when compared to both pregnant and non-pregnant controls. CONCLUSION: ; Markers of fibrin formation and fibrinolysis are significantly alerted in early onset preeclampsia; furthermore, certain markers correlate with disease severity in this patient cohort.