VPB1430 - Evaluation of hemostasis disorders and the level of neutrophil extracellular traps in pregnant women with thrombophilia

Background: Three main factors have been found to play the leading role in the occurrence of thromboembolic complications in pregnant women: genetic thrombophilia, hyperhomocysteinemia and antiphospholipid syndrome. However, the detailed mechanisms responsible for adverse pregnancy outcomes in the presence of thrombophilia remain incompletely understood.

Aims: The purpose of this study was to identify the relationship between hemostasis disorders and trapped DNA levels in pregnant women with a history of obstetric complications.

Methods: 337 women with thrombophilia and placental insufficiency (age 19 to 36 years, median age 29 years) in the second trimester of pregnancy were examined. A control group consisted of 34 nonpregnant women aged 21 to 35 years (median age 28 years). Hemostasis studies were performed using routine tests and the laboratory diagnostic system "Thrombodynamics Registrator T-2" ("HemaCore", Russia). The level of neutrophil extracellular traps (NETs) in whole blood smears was counted using the automatic microscopy system.

Results: Analysis of platelet count, TV, ACTV, PV, AT III did not reveal statistically significant differences in the comparison groups. Fibrinogen levels in pregnant women were 1.3 times higher than in the control group (p < 0.05). The baseline clot growth rate, clot size, and clot density were found to be statistically significantly higher in the examined pregnant women with thrombophilia than in the control group (p < 0.05). Clot growth rate V (μm/min) and fibrin clot size at 30 min of follow-up (CS, μm) were the most informative. Non-pregnant women's %NETs averaged 5.7+/-2.7% (1.8-11.9%), while in complicated pregnancy %NETs was statistically significantly (p < 0.0001) increased at 12.6+/-4.1% (2.9-18.6%).

Conclusion(s): The findings expand our knowledge of the relationship between the immune system and hemostasis, whose disorders are associated with the risk of thromboembolic complications in pregnancy, which may contribute to the search for more effective personalized pregnancy management protocols, prediction of thrombosis threat and adequate and justified pregravid prevention.