PB1514 - Pre-delivery thrombin generation in women with non-severe post-partum hemorrhage – a nested case-control study

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

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)

BP

Brigitte Pan-Petesch

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

Yesim Dargaud

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

Liana Le Roux

Ingenior in CRB
Brest University Hospital
BREST, Bretagne, France
Theresa Schramm, MSc

PhD Student
Department of Medicine I, Clinical Division of Haematology and Haemostaseology; Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Daniel Kraemmer, MD (he/him/his)

PhD Student
Department of Medicine I, Clinical Division of Haematology and Haemostaseology; Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Johanna Gebhart, MD, PhD (she/her/hers)

Ap. Prof. Dr. PhD
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
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

Background: Postpartum hemorrhage (PPH) affects 5-10% of pregnant women and is an important cause of maternal death. Identification of a hemostatic biomarker predictive for PPH could improve peripartum management.

Aims: We aimed at exploring predelivery coagulation properties of pregnant women with thrombin generation assay (TGA).

Methods: We conducted a nested case-control study within the prospective “Study of Biological Determinants of Bleeding Postpartum” French cohort to compare women with non-severe PPH (cases, blood loss between 500 and 1000 mL) and controls without, matched for age, BMI, term and mode of delivery. Plasma was collected at entry in the delivery room and blood loss was measured objectively. TGA with low tissue factor concentration was performed (Technothrombin, Technoclone, Vienna, Austria).

Results: 372 women (186 cases, 186 controls) were investigated (Figure 1). There was no difference in TGA parameters between cases and controls, irrespective of mode of delivery: median lag phase = 14.1 (IQR 12.6-15.1) versus 14.1(IQR 12.1-15.6) min; median thrombin peak = 294.9 (IQR 237.4-391.1) versus 315.5 (IQR 239.1-388.5) nM; median time to peak = 23.6 (IQR 20.6-25.6) versus 23.1 (IQR 20.5-25.6) min; median velocity index = 23.1 (IQR 20.6-25.1) versus 23.1 (IQR 20.4-25.6) nM/min; median AUC = 5418 (IQR 4977-5926) versus 5352 (IQR 5038-5883) nM.min (Figure 2). Interestingly, there was a correlation, albeit weak, between blood loss and time to peak in women delivering vaginally (r = 0.21, p = 0.01). Furthermore, lag phase and thrombin peak were correlated with platelet count (r = - 0.21, p < 0.0001; r = 0.14, p = 0.0087), immature platelet fraction (r = 0.24, p < 0.0001; r = - 0.13, p = 0.01) and aPTT ratio (r = 0.20, p = 0.0002; r = - 0.25, p < 0.0001).

Conclusion(s): TGA parameters determined predelivery did not discriminate between women with and without non-severe PPH.