Fibrinolytic Activity and Protein C in Preeclampsia

Summary

Various parameters of the fibrinolytic system and antigenic and functional protein C and its inhibitor were studied during normal pregnancy and in patients with preeclampsia.

The fast acting tissue-type plasminogen activator inhibitor level was found to increase progressively during normal pregnancy. This increase was more evident in cases of severe preeclampsia (p<0.05). No variations were observed in protein C levels in normal pregnancies but a reduction in protein C level was noted in patients with severe preeclampsia (p<0.01). In preeclampsia, the protein C inhibitor level was higher than in normal pregnancy; it was also higher in normal pregnancy when compared to the control group.

Keywords

Pregnancy - Preeclampsia - Fibrinolytic activity - Protein C - t-PA inhibitor

• References

• 1 Hustin J, Foidart JM, Lambotte R. Maternal vascular lesions in preeclampsia and intrauterine growth retardation: light microscopy and immunofluorescence. Obstet Gynec Survey 1985; 40: 145-149
• 2 McCartney CP. Renal morphology and function among patients with preeclampsia and gravidas with essential hypertension. Clin Obstet Gynaecol 1968; 11: 506-521
• 3 Inglis TCM, Stuart J, George AJ, Davies HJ. Haemostatic and rheological changes in normal pregnancy and preeclampsia. Br J Haematol 1982; 50: 461-465
• 4 Graeff H, Von Hugo R, Schrock R. Recent aspects of hemostasis, hematology and hemorrheology in preeclampsia-eclampsia. Europ J Obstet Gynec reprod Biol 1984; 17: 91-102
• 5 Condie RG, Ogston D. Sequential studies on components of the haemostatic mechanism in pregnancy with particular reference to the development of preeclampsia. Br J Obstet Gynaecol 1976; 83: 938-943
• 6 Borok GGZ, Weitz J, Owen MA, Nosel HL. Fibrinogen proteolysis and platelet a-granule release in preeclampsia/eclampsia. Blood 1984; 63: 525-531
• 7 Beller FK, Ebert Ch, Dame WR. High molecular fibrin derivatives in pre-eclamptic and eclamptic patients. Europ J Obstet Gynec reprod Biol 1979; 9: 105-110
• 8 Maki ME. Coagulation, fibrinolysis, platelet and kinin forming systems during toxemiaof pregnancy. Biol Res in Pregnancy 1983; 4: 152-154
• 9 Arocha Pinango CL, Ojeda A, Lopez G, Carcia L, Linares J. Beta-Thromboglobulin (β-TG) and platelet factor 4 (PF4) in obstetrical cases. Acta Obstet Gynecol Scand 1985; 64: 115-120
• 10 Terao T, Kobayashi T. The role of placental urokinase inhibitor in toxemia of pregnancy. Biol Res in Pregnancy 4 1983; 145-151
• 11 Gow L, Campbell DM, Ogston D. Blood levels of proteinase inhibitors in pre-eclampsia. . Br J Obstet Gynaecol 1983; 90: 950-952
• 12 Gibson B, Hunter D, Neame PB, Kelton JG. Thrombocytopenia in preeclampsia and eclampsia. Sem Thromb Hemostas 1982; 8: 234-247
• 13 Weiner CP, Kwaan HC, Chu X, Paul M, Burmeister L, Hauck W. Antithrombin III activity in women with hypertension during pregnancy. Obstet Gynecol 1985; 65: 301-306
• 14 Weenink GH, Treffers PE, Vijn P, Smorenberg-Schoorl ME, Ten Cate JW. Plasma antithrombin levels in preeclampsia. Clin Exper Hyper 1983; 1: 145-162
• 15 Weenink GH, Treffers PE, Vijn P, Smorenberg-Schoorl ME, Ten Cate JW. Antithrombin III levels in preeclampsia correlate with maternal and fetal morbidity. Am J Obstet Gynecol 1984; 148: 1092-1097
• 16 Wiman B, Csemiczky G, Marsk L, Robbe H. The fast inhibitor of tissue plasminogen activator in plasma during pregnancy. Thromb Haemostas 1984; 52: 124-126
• 17 Astedt B, Holmberg L, Nilson IM. An inhibitor of t-PA in pregnant plasma. Haemostasis 1984; 1: 101
• 18 Chmielewska J, Ranby M, Wiman B. Evidence for a rapid inhibitor to tissue plasminogen activator in plasma. Thromb Res 1983; 31: 427-436
• 19 Marlar RA. Protein C in thromboembolic disease. Sem Thromb Hemostas 1985; 11: 387-393
• 20 Mannucci PM, Vigano S, Bottasso B, Candotti G, Bozzetti D, Rossi E, Pardi G. Protein C antigen during pregnancy, delivery and puerperium. Thromb Haemostas 1984; 52: 217
• 21 Pritchard JA, MacDonald PC. In: Hypertensive disorders in pregnancy Williams-Obstetrics New York: Appleton Century Crofts; 1980: 665-700
• 22 Haesslein HC. Hypertensive disease. In: Manual of Obstetrics, diagnosis and therapy Niswander KR. (ed) Little, Browan and Company; Boston: 1980: 213-225
• 23 Friberger P, Knoss M, Gustavsson S, Ansell L, Claeson G. Methods for determination of plasmin, antiplasmin and plasminogen by means of substrate S-2251. Haemostasis 1978; 7: 138-145
• 24 Teger-Nilsson AC, Friberger P, Gyzander E. Determination of a new rapid plasmin inhibitor in human blood by means of a plasmin specific tripeptide substrate. Scand J Clin Lab Invest 1977; 37: 403-409
• 25 Bergsdorf M, Nilsson T, Wallen P. An enzyme-linked immunosorbent assay for determination of tissue plasminogen activator applied to patients with thromboembolic disease. Thromb Haemostas 1983; 50: 740-744
• 26 Francis Jr RB, Patch MJ. A functional assay for protein C in human plasma. Thromb Res 1983; 32: 605-613
• 27 Francis Jr RB, Thomas W. Behaviour of protein C inhibitor in intravascular coagulation and liver disease. Thromb Haemostas 1984; 52: 71-74
• 28 Gilabert J, Aznar J, Parrilla JJ, Reganon E, Vila V, Estelles A. Alterations in the coagulation and fibrinolysis system in pregnancy, labour and puerperium, with special reference to a possible transitory state of intravascular coagulation during labour. Thromb Haemostas 1978; 40: 387-396
• 29 Hedner U, Astedt B. Studies on fibrinolytic inhibitors during pregnancy. Acta Obstet Gynaecol Scand 1971; 50: 90-103
• 30 Walker JE, Campbell DM, Ogston D. Blood levels of proteinase inhibitors in pregnancy. Br J Obstet Gynaecol 1982; 89: 208-210
• 31 Bonnar J. Blood coagulation and fibrinolysis in human pregnancy. Bibl Anat 1973; 12: 58-63
• 32 Hellgren M, Blomback M. Studies on blood coagulation and fibrinolysis in pregnancy, delivery and puerperium. I. Normal condition. Gynecol Obstet Invest 1984; 12: 141-154
• 33 Stirling Y, Woolf L, North WR S, Seghatchian MJ, Meade TW. Haemostasis in normal pregnancy. Thromb Haemostas 1984; 52: 176-182
• 34 Astedt B, Lecander I, Brodin T, Lundblad A, Læw K. Purification of a specific placental plasminogen activator inhibitor by monoclonal antibody and its complex formation with plasminogen activator. Thromb Haemostas 1985; 53: 122-125
• 35 Taylor Jr FB, Lockhard MS. A new function for activated protein C: activated protein C prevents inhibition of plasminogen activators by releasate from mononuclear leukocytes-platelet suspensions stimulated by phorbol diester. Thromb Res 1985 37: 155-164
• 36 Van Hinsbergh VW M, Bertina RM, Van Wijngaarden A, Van Tilburg NH, Emeis JJ, Haverkate F. Activated protein C decreases plasminogen activator inhibitor activity in endothelial cell-conditioned medium. Blood 1985; 65: 444-451
• 37 Aznar J, Dasí A, España F, Estellés A. Fibrinolytic study in a homozygous protein C deficient patient. Thromb Res (in press)