OC 02.4 - Women with severe postpartum hemorrhage have a decreased endogenous thrombin potential before delivery

Saturday, June 24, 2023

13:45 – 14:00 ET

Room: 710A

Session Available As: Live-Stream and On-Demand

Presenting Author(s)

Claire de Moreuil, MD,PhD (she/her/hers)

Hospital Practioner in Internal Medicine
Internal medicine and Pneumology Department, Brest University Hospital, UMR 1304, GETBO
BREST, Bretagne, France

Co-Author(s)

YD

Yesim Dargaud

MD, PhD
Hemostasis department, Lyon University Hospital
LYON, Rhone-Alpes, France
CN

Christophe Nougier

MD
Hemostasis department, Lyon University Hospital
LYON, Rhone-Alpes, France
PD

Pierre-François Dupré

MD
Obstetrics and Gynecology ward, Brest University Hospital
BREST, Bretagne, France
CT

Christophe Trémouilhac

MD
Obstetrics and Gynecology ward, Brest University Hospital
BREST, Bretagne, France
DL

Delphine Le Joliff

MD
Quimper Hospital
QUIMPER, Bretagne, France
SR

Sylvain Rosec

Technician in CRB
Brest University Hospital
BREST, Bretagne, France
Ingrid Pabinger, MD

Co-Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Cihan Ay, MD (he/him/his)

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Francis Couturaud, PhD (he/him/his)

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
BP

Brigitte Pan-Petesch

MD
CRC-MHC Brest – Service Hématologie, Unité Hémostase Clinique
BREST, Bretagne, France

Background: Severe postpartum hemorrhage (PPH), defined as a blood loss ≥ 1000mL, affects 2% of pregnant women and is associated with maternal morbi-mortality.

Aims: We aimed at characterizing coagulation properties of plasmas from pregnant women collected predelivery with thrombin generation assay (TGA) and hemostatic biomarkers (tissue factor (TF), PAI-1, thrombomodulin).

Methods: A nested case-control study was conducted within the “Study of Biological Determinants of Bleeding Postpartum”, a prospective French cohort study, in order to compare women with severe PPH (cases) and controls without PPH, matched for age, BMI, term and mode of delivery. Plasma was collected at entry in the delivery room and blood loss was measured objectively. The endogenous thrombin generation potential was measured in platelet-poor plasma with the Calibrated Automated Thrombinography (Stago, France), using low TF concentration (1 pM final). Hemostatic biomarkers were measured using ELISA kits.

Results: 142 women (71 cases and 71 controls) were investigated (Figure 1). There was no difference in median lag phase, thrombin peak and time to peak between cases and controls. However, median Area Under the Curve (AUC) was lower in cases compared with controls (2170, IQR 2020-2412 versus 2408, IQR 2233-2779 nM.min, p < 0.0001), independently of mode of delivery and of PPH etiology (Figure 2A). We also observed an inverse correlation between blood loss and AUC (r = - 0.25, p = 0.003) (Figure 2B). Median PAI-1 and TF levels were higher in cases compared with controls (107.4, IQR 69.6-120.0 versus 68.1, IQR 51.1-120.0 ng/ml, p = 0.0003; 34.4, IQR 20.4-51.1 versus 27.4, IQR 21.0-37.2 pg/ml, p = 0.007), whereas thrombomodulin levels did not differ between the two groups.

Conclusion(s): Among TGA parameters, predelivery AUC values may have a predictive value for severe PPH. Low AUC values in women with severe PPH are in accordance with a hypocoagulable state.

Learning Objectives:

Upon completion, participant will be able to evaluate the utility of Thrombin Generation Assay (TGA) to predict severe PPH from plasma collected predelivery at the entry in the delivery room.
Upon completion, participant will be able to explore different biomarkers potentially predictive for bleeding.
Upon completion, participant will be able to recall the clinical and biological risk factors for severe PPH, as well as the various etiologies for PPH according to the "4T rule" classification.