Challenges in the evaluation of D-dimer and fibrinogen levels in pregnant women

Barbara Réger, Ágnes Péterfalvi, Ilona Litter, László Pótó, Réka Mózes, Orsolya Tóth, G. Kovács, Hajna Losonczy

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Introduction Normal pregnancy is associated with hypercoagulable state. Elevated markers of coagulation and fibrinolytic system activation indicate increased thrombin activity and increased fibrinolysis following fibrin formation throughout pregnancy. These changes exceed the biological variability in most cases. Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. The aim of the study was to follow the changes of haemostatic parameters and to establish gestational age-specific reference intervals during normal pregnancy. Materials and methods Blood samples of 83 pregnant women were collected at gestational weeks 16, 26 and 36. Fibrinogen, D-dimer, and C-Reactive Protein (CRP) were examined. Reference intervals were calculated for fibrinogen, D-dimer tests with two different methods (mean ± 2 SD or median and 2.5th and 97.5th percentiles with 90% confidence intervals). Results fibrinogen and D-dimer increased progressively throughout pregnancy. Mean fibrinogen levels were higher than the maximum of the conventional reference interval, already in the 16th week of pregnancy. D-dimer levels were at or above the conventional cutoff point (250 ng/mL) throughout the pregnancy in 42% of pregnant women, while in the 36th week 98% of them displayed elevated D-dimer levels. CRP did not increase in normal pregnancy. Conclusions There seems to be an emerging need to reconsider fibrinogen and D-dimer values from a different aspect in pregnancy compared to non-pregnant reference intervals. New reference ranges are suggested to be established in pregnancy.

Original languageEnglish
JournalThrombosis Research
Volume131
Issue number4
DOIs
Publication statusPublished - Apr 2013

Fingerprint

Fibrinogen
Pregnant Women
Pregnancy
Hemostatics
Hemostatic Disorders
fibrin fragment D
Dilatation and Curettage
Fibrinolysis
Fibrin
Thrombin
C-Reactive Protein
Gestational Age
Reference Values
Confidence Intervals

Keywords

  • D-dimer
  • Fibrinogen
  • Gestational age-specific reference intervals
  • Pregnancy

ASJC Scopus subject areas

  • Hematology

Cite this

Réger, B., Péterfalvi, Á., Litter, I., Pótó, L., Mózes, R., Tóth, O., ... Losonczy, H. (2013). Challenges in the evaluation of D-dimer and fibrinogen levels in pregnant women. Thrombosis Research, 131(4). https://doi.org/10.1016/j.thromres.2013.02.005

Challenges in the evaluation of D-dimer and fibrinogen levels in pregnant women. / Réger, Barbara; Péterfalvi, Ágnes; Litter, Ilona; Pótó, László; Mózes, Réka; Tóth, Orsolya; Kovács, G.; Losonczy, Hajna.

In: Thrombosis Research, Vol. 131, No. 4, 04.2013.

Research output: Contribution to journalArticle

Réger, B, Péterfalvi, Á, Litter, I, Pótó, L, Mózes, R, Tóth, O, Kovács, G & Losonczy, H 2013, 'Challenges in the evaluation of D-dimer and fibrinogen levels in pregnant women', Thrombosis Research, vol. 131, no. 4. https://doi.org/10.1016/j.thromres.2013.02.005
Réger, Barbara ; Péterfalvi, Ágnes ; Litter, Ilona ; Pótó, László ; Mózes, Réka ; Tóth, Orsolya ; Kovács, G. ; Losonczy, Hajna. / Challenges in the evaluation of D-dimer and fibrinogen levels in pregnant women. In: Thrombosis Research. 2013 ; Vol. 131, No. 4.
@article{b058ab6a64644fce98dc9c4899877f05,
title = "Challenges in the evaluation of D-dimer and fibrinogen levels in pregnant women",
abstract = "Introduction Normal pregnancy is associated with hypercoagulable state. Elevated markers of coagulation and fibrinolytic system activation indicate increased thrombin activity and increased fibrinolysis following fibrin formation throughout pregnancy. These changes exceed the biological variability in most cases. Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. The aim of the study was to follow the changes of haemostatic parameters and to establish gestational age-specific reference intervals during normal pregnancy. Materials and methods Blood samples of 83 pregnant women were collected at gestational weeks 16, 26 and 36. Fibrinogen, D-dimer, and C-Reactive Protein (CRP) were examined. Reference intervals were calculated for fibrinogen, D-dimer tests with two different methods (mean ± 2 SD or median and 2.5th and 97.5th percentiles with 90{\%} confidence intervals). Results fibrinogen and D-dimer increased progressively throughout pregnancy. Mean fibrinogen levels were higher than the maximum of the conventional reference interval, already in the 16th week of pregnancy. D-dimer levels were at or above the conventional cutoff point (250 ng/mL) throughout the pregnancy in 42{\%} of pregnant women, while in the 36th week 98{\%} of them displayed elevated D-dimer levels. CRP did not increase in normal pregnancy. Conclusions There seems to be an emerging need to reconsider fibrinogen and D-dimer values from a different aspect in pregnancy compared to non-pregnant reference intervals. New reference ranges are suggested to be established in pregnancy.",
keywords = "D-dimer, Fibrinogen, Gestational age-specific reference intervals, Pregnancy",
author = "Barbara R{\'e}ger and {\'A}gnes P{\'e}terfalvi and Ilona Litter and L{\'a}szl{\'o} P{\'o}t{\'o} and R{\'e}ka M{\'o}zes and Orsolya T{\'o}th and G. Kov{\'a}cs and Hajna Losonczy",
year = "2013",
month = "4",
doi = "10.1016/j.thromres.2013.02.005",
language = "English",
volume = "131",
journal = "Thrombosis Research",
issn = "0049-3848",
publisher = "Elsevier Limited",
number = "4",

}

TY - JOUR

T1 - Challenges in the evaluation of D-dimer and fibrinogen levels in pregnant women

AU - Réger, Barbara

AU - Péterfalvi, Ágnes

AU - Litter, Ilona

AU - Pótó, László

AU - Mózes, Réka

AU - Tóth, Orsolya

AU - Kovács, G.

AU - Losonczy, Hajna

PY - 2013/4

Y1 - 2013/4

N2 - Introduction Normal pregnancy is associated with hypercoagulable state. Elevated markers of coagulation and fibrinolytic system activation indicate increased thrombin activity and increased fibrinolysis following fibrin formation throughout pregnancy. These changes exceed the biological variability in most cases. Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. The aim of the study was to follow the changes of haemostatic parameters and to establish gestational age-specific reference intervals during normal pregnancy. Materials and methods Blood samples of 83 pregnant women were collected at gestational weeks 16, 26 and 36. Fibrinogen, D-dimer, and C-Reactive Protein (CRP) were examined. Reference intervals were calculated for fibrinogen, D-dimer tests with two different methods (mean ± 2 SD or median and 2.5th and 97.5th percentiles with 90% confidence intervals). Results fibrinogen and D-dimer increased progressively throughout pregnancy. Mean fibrinogen levels were higher than the maximum of the conventional reference interval, already in the 16th week of pregnancy. D-dimer levels were at or above the conventional cutoff point (250 ng/mL) throughout the pregnancy in 42% of pregnant women, while in the 36th week 98% of them displayed elevated D-dimer levels. CRP did not increase in normal pregnancy. Conclusions There seems to be an emerging need to reconsider fibrinogen and D-dimer values from a different aspect in pregnancy compared to non-pregnant reference intervals. New reference ranges are suggested to be established in pregnancy.

AB - Introduction Normal pregnancy is associated with hypercoagulable state. Elevated markers of coagulation and fibrinolytic system activation indicate increased thrombin activity and increased fibrinolysis following fibrin formation throughout pregnancy. These changes exceed the biological variability in most cases. Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. The aim of the study was to follow the changes of haemostatic parameters and to establish gestational age-specific reference intervals during normal pregnancy. Materials and methods Blood samples of 83 pregnant women were collected at gestational weeks 16, 26 and 36. Fibrinogen, D-dimer, and C-Reactive Protein (CRP) were examined. Reference intervals were calculated for fibrinogen, D-dimer tests with two different methods (mean ± 2 SD or median and 2.5th and 97.5th percentiles with 90% confidence intervals). Results fibrinogen and D-dimer increased progressively throughout pregnancy. Mean fibrinogen levels were higher than the maximum of the conventional reference interval, already in the 16th week of pregnancy. D-dimer levels were at or above the conventional cutoff point (250 ng/mL) throughout the pregnancy in 42% of pregnant women, while in the 36th week 98% of them displayed elevated D-dimer levels. CRP did not increase in normal pregnancy. Conclusions There seems to be an emerging need to reconsider fibrinogen and D-dimer values from a different aspect in pregnancy compared to non-pregnant reference intervals. New reference ranges are suggested to be established in pregnancy.

KW - D-dimer

KW - Fibrinogen

KW - Gestational age-specific reference intervals

KW - Pregnancy

UR - http://www.scopus.com/inward/record.url?scp=84875690813&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875690813&partnerID=8YFLogxK

U2 - 10.1016/j.thromres.2013.02.005

DO - 10.1016/j.thromres.2013.02.005

M3 - Article

C2 - 23481480

AN - SCOPUS:84875690813

VL - 131

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

IS - 4

ER -