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Journal of Thrombosis and Haemostasis 06/2011; 9(8):1669-70. · 5.73 Impact Factor
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ABSTRACT: To study cardiovascular risk markers in women taking estradiol/trimegestone or estradiol/dydrogesterone.
Multicenter, randomized, prospective, double-blind study of 184 healthy post-menopausal women randomized to 6 cycles of either estradiol (2mg)+trimegestone (0.5mg) (T-group) or estradiol (2mg)+dydrogesterone (10mg) (DYDR group). Cardiovascular risk markers were measured before, after cycle 1, 3 and 6 and at 4 weeks post-treatment.
Fibrinogen was reduced in both groups but more markedly in the DYDR group. Factor VIIc activity levels decreased in both groups with a greater change in the T-group. Factor VII antigen was increased in both groups with a greater increase in the DYDR group. Factor VIIa was increased in the DYDR group only. Plasminogen levels were also increased in both groups with a greater increase in the T-group. There were no statistically significant changes in lipid variables between the different regimens. Changes in total cholesterol and LDL cholesterol were correlated positively with changes in factor VIIc in the DYDR group and negatively with changes in factor VIIc in the T-group. Trigemestone was associated with a better bleeding pattern.
Trimegestone was associated with less procoagulant changes in factor VIIa and factor VIIc activity and larger decrease in PAI-1 activity compared with the dydrogesterone preparation. These results reflect less androgenic properties of the trimegestone preparation. The fibrinogen level and Lp(a) were more decreased during dydrogesterone treatment. Further investigation is required to clarify the relative importance of beneficial effects with respect to cardiovascular risk.
Maturitas 04/2009; 62(3):287-93. · 2.77 Impact Factor
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ABSTRACT: The Sonoclot analyser provides global measurement of haemostasis, including plasma coagulation, platelet function and fibrinolysis. Benefits of its use in cardiovascular and hepatic surgery are well-documented and it may be useful in managing obstetric complications. The aim of this study was to determine ranges of the Sonoclot variables for normal pregnancy.
Prospective and longitudinal study.
Antenatal outpatient clinic, university hospital.
Forty-seven healthy women were studied; forty-two completed normal pregnancies and gave birth to healthy infants.
None.
Sonoclot signatures were performed at 10-15, 32-34 and 38-40 weeks of gestation and at 8 weeks postpartum. Haemoglobin concentration, haematocrit, platelet count, fibrinogen and activated partial thromboplastin time (APTT) were analysed with normal results. Sonact time and peak time were significantly decreased and clot rate and secondary rate were significantly increased during pregnancy compared with 8 weeks postpartum, indicating hypercoagulability. There were no significant changes in these variables during pregnancy. There were no changes in peak amplitude and downward rate. A significant correlation was found between sonact time and APTT, and between clot rate and APTT.
We found the Sonoclot analyser simple to handle and the signatures easy to interpret. The ranges for the Sonoclot variables apply throughout pregnancy. The ranges for sonact time, clot rate, secondary rate and peak time during pregnancy differed from the ranges at 8 weeks postpartum.
Intensive Care Medicine 03/2000; 26(2):206-11. · 5.40 Impact Factor
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ABSTRACT: Forty-eight healthy pregnant women were studied prospectively and longitudinally. Blood sampling was performed at 10-15, 23-25, 32-34 and 38-40 weeks of gestation, within one week and at eight weeks postpartum. Classic and modified activated protein C ratio decreased as pregnancy progressed. In the third trimester 92% of the ratios measured with the classic test were above the lower reference level whereas all modified test ratios were normal. Slight activation of blood coagulation was shown with increased levels of prothrombin fragment 1+2, soluble fibrin and D-dimer. Fibrinogen, factor VIII and plasminogen activator inhibitor type I and type 2 increased. Protein S and tissue plasminogen activator activity decreased. Protein C remained unchanged. No correlation was found between the decrease in classic APC ratio and changes in factor VIII, fibrinogen, protein S, prothrombin fragment 1+2 or soluble fibrin, nor between the increase in soluble fibrin and changes in prothrombin fragment 1+2, fibrinogen and D-dimer.
Thrombosis and Haemostasis 05/1999; 81(4):527-31. · 5.04 Impact Factor
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ABSTRACT: To investigate the effect of subcutaneous heparin treatment on calcium homeostasis in pregnancy.
A longitudinal case-control observational study.
Department of Obstetrics and Gynaecology, Karolinska Hospital, Stockholm, Sweden.
36 pregnant women with previously verified thromboembolic complications and 23 healthy pregnant control women similar in age, parity, weight, and smoking habit.
Thromboprophylaxis during pregnancy and 6 weeks post partum was given with subcutaneous heparin twice daily to the 36 women with a history of thromboembolic complications, 16 received an average dose of 24,500 IU/day and 20 a mean dose of 17,300 IU/day. Venous blood and urine samples were obtained every 4 weeks.
Serum concentrations of total calcium, ionized calcium, calcitonin and urinary calcium.
Women on high-dose heparin treatment showed significantly higher concentrations of total and ionized calcium and of calcitonin in serum and significantly lower concentrations of calcium in urine than did 23 normal pregnant controls. The differences were most pronounced in the third trimester. The results obtained in the low-dose heparin group were between those in the high-dose and the control groups. At 8 weeks postpartum there were no significant differences between the heparin-treated women and the controls. No significant differences were found during pregnancy in haematocrit, liver or renal function, serum levels of albumin, phosphate, magnesium, alkaline phosphatase, parathyroid hormone or urinary cyclic AMP.
Heparin treatment during pregnancy results in changes in calcium homeostasis and a dose-dependent response is suggested.
British Journal of Obstetrics and Gynaecology 06/1992; 99(5):412-6.
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ABSTRACT: To identify changes in haemostatic balance during continuous oestradiol-progestogen treatment, 60 postmenopausal women with climacteric complaints, mean age 55.4 years (range 44-68) were randomly allocated to receive one of four hormone replacement regimens for one year. All four formulations were administered daily and continuously, each contained 2 mg of 17 beta-oestradiol in combination with either norethisterone acetate, 1 mg (group A) or 0.5 mg (group B) or megestrol acetate, 5 mg (group C) or 2.5 mg (group D). No significant changes occurred during treatment within or between the groups in platelet count, fibrinogen and 2-antiplasmin. Activated partial thromboplastin time was shortened (P less than 0.05) in group D and a decline in factor VII activity and antigen (P less than 0.001) and in ATIII activity (P less than 0.05) was noted in group A. Protein C tended to decline in all treatment groups but statistically significant changes were noted only in groups A and C. Two women developed crural thrombosis during the observation period.
British Journal of Obstetrics and Gynaecology 11/1990; 97(10):939-44.
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American Journal of Obstetrics and Gynecology 06/1990; 162(5):1338-9. · 3.47 Impact Factor
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ABSTRACT: Osteopenia, sometimes with compression fractures of the spine, is a side-effect of long-term heparin treatment. The frequency is unknown. In this study, 70 women were given subcutaneous heparin as therapy for, or prophylaxis against, thromboembolism during pregnancy. All, except two, were examined by X-ray of the spine and hip first week post partum. The duration of treatment and the dosage of heparin varied. There were 12 (17%) with obvious osteopenia, including two women with multiple fractures of the spine (3%). Re-examination 6-12 months post partum showed that the changes were reversible in most cases. Another 18 women were examined about three years after heparin treatment during pregnancy. No obvious osteopenia was found among them or in a control group of 30 women examined in the first week post partum. The degree of osteopenia was not correlated with either the heparin dose or the duration of treatment. Women treated with heparin in consecutive pregnancies do not seem to have an increased risk of osteopenia.
British Journal of Obstetrics and Gynaecology 04/1990; 97(3):221-8.
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ABSTRACT: Sixty postmenopausal women with climacteric complaints were randomly allocated to four treatment groups. Without interruption, each patient was given one tablet daily containing 2 mg 17 beta-estradiol along with either norethisterone acetate 1 mg and 0.5 mg or megestrol acetate 5 mg and 2.5 mg. Blood samples were obtained before treatment and then after 1, 4, and 12 months of treatment. Serum was analyzed for cholesterol and triglycerides in serum and for cholesterol in the ultracentrifugally separated lipoprotein fractions of very low-density lipoproteins, low-density lipoproteins, and high-density lipoproteins. Significant reductions of serum cholesterol were found in all treatment groups except for that given 2.5 mg megestrol acetate. After 1 and 4 months of treatment, low-density lipoprotein cholesterol decreased 7-22%, whereas high-density lipoprotein cholesterol was reduced by 2-16% in the four groups. No significant differences could be demonstrated among the groups in low-density lipoprotein cholesterol or high-density lipoprotein cholesterol during treatment, as assessed by analysis of variance. Thus, cholesterol metabolism was equally influenced by both progestin types. Accordingly, the clinical efficacy and acceptance would decide the preparation to be advocated for women in need of hormone replacement therapy.
Obstetrics and Gynecology 06/1989; 73(5 Pt 1):754-8. · 4.73 Impact Factor
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ABSTRACT: Sixty women with climacteric complaints who had not menstruated for at least 1 year were randomly allocated to receive one of four hormonal replacement regimens. All four formulations were administered daily and continuously and each contained 2 mg of micronized oestradiol-17 beta in combination with either norethisterone acetate 1 mg (group A) or 0.5 mg (group B) or megestrol acetate 5 mg (group C) or 2.5 mg (group D). The clinical efficacy was the same although the alleviation of vasomotor symptoms was somewhat slower in those women receiving preparation A. The endometrium was atrophied in nearly all biopsies. Irregular uterine bleeding was almost entirely confined to the earlier phase of the study and was substantially less with the formulation containing 1 mg norethisterone acetate. It is concluded that a continuous oestradiol-progestogen combination can be used for long-term treatment of climacteric complaints in postmenopausal women and that after 4 months the clinical efficacy is the same irrespective of the type and dose of progestogen administered.
British Journal of Obstetrics and Gynaecology 11/1988; 95(10):1042-8.
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Lakartidningen 08/1988; 85(28-29):2413.
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ABSTRACT: Blood coagulation and fibrinolysis variables have been studied in the normal puerperium in order to facilitate the decision to discontinue thrombosis prophylaxis after delivery. 16 women were followed longitudinally from the 1st to the 6th week post partum. Factor VIII activity and related antigen, fibrinogen, fibrinopeptide A, antithrombin III, plasminogen, tissue plasminogen activator (t-PA), fast inhibitor of t-PA, alpha 2-antiplasmin, urokinase inhibitors, fragment B beta 15-42 and kallikrein inhibition were analyzed. Both blood coagulation and fibrinolysis were significantly increased during the first 2 weeks, although simultaneously increased inhibitor capacity of both systems was present. 3 weeks post partum, blood coagulation and fibrinolysis were generally normalized, although the inhibitors remained raised compared to nonpregnant controls throughout the observation period.
Gynecologic and Obstetric Investigation 02/1985; 20(1):37-44. · 1.28 Impact Factor
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ABSTRACT: Tests generally accepted in the diagnosis of DIC were evaluated in 13 patients with multiple trauma. The blood samples were drawn on admission before treatment with blood, blood products or heparin. The tests included platelet count, prothrombin complex (Normotest/Thrombotest), Factor V, Factor VIII:C, fibrinogen, fibrinogen degradation products (FDP), thrombin and Reptilase times as well as the ethanol gelation test (fibrin monomer). Based on the results of the tests, the patients were categorized into DIC, suspected DIC and no DIC groups. It was found that those patients who were referred to the DIC group were also those who later developed the most severe organ dysfunction and who stayed the longest time in the Intensive Care Unit. Thus, the clinical and laboratory findings agreed. The Normotest/Thrombotest ratio, thrombin times and Reptilase times, and presence of fibrin monomers were of limited value for the diagnosis of DIC. To make a correct diagnosis, the results of several of the conventional tests had to be combined. Additional tests were then evaluated. An increase of the fibrinopeptide A (FPA) level and the Factor VIIIR:Ag (vWF:Ag)/Factor VIII:C ratio in all the DIC patients as well as a decrease of the antithrombin (AT) level in some DIC patients indicated thrombin activity and a risk of thromboembolic events. A decrease of plasminogen and alpha 2-antiplasmin indicated activation of the fibrinolytic system. It is concluded that these new tests are useful in the diagnosis and treatment of DIC and similar proteolytic states.
Scandinavian journal of clinical and laboratory investigation. Supplementum 02/1985; 178:15-23.
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ABSTRACT: We investigated 22 severely ill patients (21 surgical, 1 medical) at the intensive care unit. Analyses of platelet count, Normotest, antithrombin III, FDP and fibrinogen were used to divide the patients into three diagnostic groups: DIC (3 positive tests), suspected DIC (2 positive tests) and No DIC. Using these criteria 9, 8 and 5 patients were referred to these diagnostic groups, respectively. Factor XII and prekallikrein did not differ significantly between the three diagnostic groups. On the other hand the capacity of the patient plasma to inhibit kallikrein was significantly lower in the DIC group. The decrease of kallikrein inhibitory capacity was correlated to the decrease of antithrombin III and alpha 2-antiplasmin. Out of the 22 patients in the study 8 patients died, 5 of these were in the DIC group. Non-surviving patients showed lower values of the protease inhibitors than survivors. It is concluded that in this type of patients and with the laboratory methods used contact phase factors do not seem to be affected in DIC. Analyses of the kallikrein inhibitory capacity, antithrombin and alpha 2-antiplasmin on the other hand seem to be of interest to measure, though the decrease of these inhibitors could be due to consumption as well as to reduced protein synthesis. Further studies are needed to prove the prognostic value of assaying these protease inhibitors.
Scandinavian journal of clinical and laboratory investigation. Supplementum 02/1985; 178:25-9.
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Thrombosis Research 09/1984; 35(4):459-66. · 2.44 Impact Factor
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ABSTRACT: In a search for new variables, for the diagnosis of disseminated intravascular coagulation (DIC) and for guidelines of therapy in such conditions, 22 severely ill patients were studied. The diagnosis of DIC was based on determinations of platelet counts, prothrombin complex (Normotest), antithrombin (AT), fibrinogen degradation products and fibrinogen. Nine patients were diagnosed as having DIC, eight patients were referred to a suspected DIC group and five to a group of no DIC. The laboratory findings were found to agree with the clinical status. In addition several new parameters were investigated: factor XII, prekallikrein, Simplastin A--another prothrombin complex factor method, factor X, plasminogen (PLG), antiplasmin (AP) and kallikrein inhibitors (KI). Platelet counts, prothrombin complex and antithrombin were mostly pathological in DIC-patients. Of the alternative tests prothrombin complex, fibrinopeptide A and the kallikrein inhibitor as well as the two tests for fibrinolysis (PLG and AP) were significantly altered in DIC-patients. The inhibitor capacity (AT, APV and KI) was lower in patients who died than in survivors and decreased still further in those of the non-survivors who had DIC. Thus the inhibitors can be used as predictors of outcome and hopefully for guiding therapy. To establish the diagnosis of DIC we suggest measurement of platelet count, prothrombin complex, plasminogen as well as of the inhibitors.
Intensive Care Medicine 02/1984; 10(1):23-8. · 5.40 Impact Factor
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ABSTRACT: Acute fatty liver (AFLP) is a rare complication of late pregnancy. The maternal and fetal mortality has earlier been reported to be about 75%, but during the last decade a reduced mortality to about 30 and 50%, respectively, has been reported in the literature. Disseminated intravascular coagulation (DIC) has been suggested as a contributing cause to the high mortality. The treatment of DIC has long been under debate, and recently the administration of antithrombin III (AT) concentrate in addition to other supportive treatment has been reported successful. This paper presents the survival of 1 patient with severe liver and renal failure indicating AFLP complicated by severe disturbances in blood coagulation and fibrinolysis. The patient was treated with AT concentrate and small doses of heparin, blood coagulation factors, large amounts of glucose intravenously and supportive intensive care. The pregnancy was terminated by cesarean section. The child was stillborn and 75% of the placental parenchyma was fibrosed.
Gynecologic and Obstetric Investigation 02/1983; 16(2):107-18. · 1.28 Impact Factor
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Thrombosis Research 04/1982; 25(5):433-6. · 2.44 Impact Factor
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ABSTRACT: The incidence of thromboembolic complications (TE) during pregnancy in women with congenital antithrombin III (AT) deficiency has retrospectively been estimated to be about 70%. 8 women with congenital AT deficiency were studied during 9 pregnancies. Subcutaneous or intravenous heparin in doses to prolong the activated partial thromboplastin time (APTT) was given during pregnancy as prophylaxis or therapeutic treatment. During delivery and abortion the AT level was brought to normal by infusion of AT concentrate and the heparin was reduced or withdrawn. Four pregnancies were uncomplicated with regard to TE and resulted in 4 healthy children. Five pregnancies were terminated by induced or spontaneous abortion. 1 woman had TE during heparin prophylaxis and 2 women had TE before the prophylaxis was started. 1 of the latter suffered from a new TE during continued heparing treatment. Insufficient prolongation of APTT was registered at the time of TE in both women with TE during heparin treatment.
Gynecologic and Obstetric Investigation 02/1982; 14(2):127-41. · 1.28 Impact Factor
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Acta Obstetricia Et Gynecologica Scandinavica 02/1982; 61(2):187-9. · 1.77 Impact Factor
