Modifications of coagulation imbalance during antithrombin treatment in preeclamptic patients: our experience

Introduction

Preeclamptic conditions are often associated with a natural inhibitor consumption. Many studies have evidenced validity of antithrombin (AT) treatment during preeclamptic conditions. The aim of the study is to restore a congruous coagulation imbalance with administration of AT under the guide of thromboelastographic monitoring (TEG).

Methods

Ten preeclamptic pregnant women in the 24th–30th weeks with diastolic blood pressure >90 mmHg and urinary protein level 24 hours >0.3 g were included. All patients were submitted to a complete study of coagulation function: prothrombin time (PT), activated partial thromboplastin time (aPTT), International Normalization Ratio (INR), fibrinogen C, D-dimer, AT and TEG at the beginning, after every administration of AT, weekly until caesarean section, and daily for 1 week in the postoperative period. AT was administered every time the AT plasmatic level was less than 80% to restore the plasmatic level to more than 120% using the following algorithm: (120% - AT plasmatic level) × kg. At the beginning, only seven patients were treated with AT.

Results

At the beginning, all patients showed AT consumption and a hypercoagulation TEG (Figure 1), but the INR and aPTT were in the normal ranges. Patients treated with AT at the beginning did not need a new administration. The remaining patients were treated at the 31st, 33rd and 34th weeks, respectively. In all patients, AT administration determined a normalization of TEG without any modification of the PT and aPTT or bleeding. All patients were submitted to caesarean section between the 36th and 39th weeks.

Figure 1

Thromboelastographic monitoring at admission.

Conclusion

AT administration could play a central role in preeclampsia treatment. TEG monitoring evidenced, in real time, coagulation changes that common laboratory tests could not show.