Naslov
Lupus anticoagulant (LAC) positive and negative pregnancies. Platelet count and aggregation, blood floow indices and therapeutic effect of aspirin and heparin

Autori
Škrablin, Snježana ; Kuvačić, Ivan ; Kralik, Saša ; Bernt, Tajana ; Kalafatić, Držislav

Izvornik
Gynaecologia et perinatologia (1330-0091) 7 (1998), 4; 149-152

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
LAC; doppler velocimetry; aspirin; heparin; habitual pregnancy vastage

Sažetak
Platelet activation might be a link between LAC positivity and adverse pregnancy outcome. The aim of this study was to test the benefit of anticoagulant therapy. Prospective, nonrandomised analysis of LAC, platelet count and platelet aggregation in 121 selected high risk pregnancies cared for during a 5 year period. Forty five (45) women received aspirin, 14 women received aspirin and heparin, 20 women the combination of aspirin, heparin and prednisone, while 42 women remained unmedicated. The therapy started not earlier than early second trimester. LAC was tested during the first, second and third trimester. Platelet aggregation was analyzed, using collagen, ADP and arachidonic acid, once prior to the start of the therapy. Umbilical, arcuate and fetal aortal blood flow were analyzed in pregnancies surviving into second trimester. The outcome of pregnancy was put in correlation with LAC positivity and the therapy. SPSS 6.1 software program was used for statistical analysis. Only 15 out of 121 high risk pregnancies /12.4%/ were LAC positive. Significant correlation was found between LAC positivity and fetal death (p=0.008). In LAC positive cases, platelet count was significantly lower in the first as well as in the second trimester (p=0.01, p=0.05, respectively), their aggregation was significantly decreased, (p=0.001 when stimulated by arachidonic acid and p= 0.03 by ADP), and, later in pregnancy, there was significantly increased downstream resistance in umbilical arteries (p=0.03) and in fetal aorta (p=0.03). If instituted not earlier than second trimester, no influence of the therapy on the outcome in LAC positive women was observed. In LAC negative cases, anticoagulant therapy proved to be highly more successful than no medication at all (p=0.006). Significantly lower platelet count and significantly prolonged and less pronounced platelet aggregation, together with ineffective therapy if started after the first trimester, points toward increased platelet exhaustion early in pregnancy in LAC positive cases. Increased downstream resistance in umbilical and in arcuate arteries with LAC positivity might locate increased platelet activation within implanting placenta.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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