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Platelet aggregation and thromboelastometry monitoring in women with preeclampsia: a prospective observational study
Malin Andersson1, Peter Bengtsson1, Ove Karlsson1
1Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Preeclampsia alters coagulation, with hyperactivation at normal platelet counts but impaired function during thrombocytopenia. Platelet count is key to understanding these coagulation changes in preeclampsia.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Reproductive Medicine
Background:
- Preeclampsia affects 12-20% of pregnancies, often impairing coagulation due to low platelet counts.
- Women with preeclampsia face increased risks of cerebral hemorrhage, thromboembolism, and postpartum hemorrhage.
- Conflicting results exist regarding platelet function and coagulation in preeclampsia.
Purpose of the Study:
- To investigate platelet aggregation and coagulation parameters in women with preeclampsia.
- To clarify the relationship between platelet count and coagulation status in preeclampsia.
Main Methods:
- Prospective observational study of women with preeclampsia and normotensive controls.
- Platelet count, impedance aggregometry for platelet aggregation, and thromboelastometry for coagulation assessment.
- Data collected from the Gothenburg Preeclampsia Adverse Event (GoPROVE) Biobank and Database.
Main Results:
- No significant differences in platelet aggregation (ADP, ASPI, TRAP tests) between groups.
- Women with preeclampsia showed lower platelet counts and shorter clotting/clot formation times.
- Hyperactivated coagulation observed in preeclampsia with normal platelet counts; impaired coagulation in thrombocytopenic preeclampsia patients.
Conclusions:
- Platelet aggregation and coagulation tests in preeclampsia are significantly influenced by platelet count.
- Normal platelet counts in preeclampsia correlate with hyperactivated coagulation.
- Thrombocytopenia in preeclampsia is associated with impaired coagulation test results.
Background:
Thrombocytopenia affects 12-20% of women with preeclampsia and a low platelet count impairs coagulation. Women with preeclampsia have an increased risk of both cerebral hemorrhage, thromboembolism, and postpartum hemorrhage. Studies of platelet function and coagulation in women with preeclampsia show conflicting results. Therefore, we aimed to study platelet aggregation and coagulation in women with preeclampsia.
Method:
Women with preeclampsia and women with normotensive pregnancies were included prior to delivery in a prospective observational study as a part of the Gothenburg Preeclampsia Adverse Event (GoPROVE) Biobank and Database. Sampling and analyses were performed shortly before delivery. Platelet count was analyzed and impedance aggregometry was used for examining platelet adhesion and aggregation. Thromboelastometry was used to assess coagulation.
Results:
Ninety-three women with preeclampsia and 45 normotensive pregnant control patients were included. There was no difference in platelet aggregation (adenosine diphosphate, ADP-test), (arachidonic acid, ASPI-test) or (thrombin receptor-activating peptide, TRAP-test) between women with preeclampsia and women with normotensive pregnancies. Women with preeclampsia had lower platelet counts, shorter clotting (EXTEM-CT and INTEM-CT) and clot formation (EXTEM-CFT and INTEM-CFT) times than women with normotensive pregnancies. Platelet aggregation and coagulation were hyperactivated in women with preeclampsia and normal platelet counts. In women with preeclampsia and thrombocytopenia, platelet aggregation and thromboelastic tests of coagulation were impaired compared with normotensive pregnancies.
Conclusion:
Platelet aggregation and thromboelastic tests of coagulation are dependent on platelet counts in women with preeclampsia. At normal platelet counts, women with preeclampsia have hyperactivated tests of coagulation. In contrast, women with thrombocytopenia demonstrated lower coagulation test values.
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