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Abstract
Objectives This study aimed to investigate hemostatic variables in pregnant patients with Systemic Lupus Erythematosus (SLE) in relation to preeclampsia (PE), antiphospholipid antibody (aPL) status and the use of thromboprophylaxis.
Methods Pregnant patients with SLE were sampled during the first and the third trimester for analysis of fibrinogen, D-dimer and global hemostatic variables, i.e. overall coagulation potential (OCP), overall haemostatic potential (OHP) and overall fibrinolysis potential (OFP). Pregnant healthy women with and without PE were sampled during the third trimester of gestation and used as controls (HC).
Results Twenty-two pregnant SLE patients, 80 pregnant HC without PE, and 42 pregnant HC with PE were included. All SLE patients received prophylaxis with low dose acetylsalicylic acid (LDASA). Low molecular weight heparin (LMWH) was given to 8 SLE patients (36,4%), of which 5 had aPL positivity, 1 antiphospholipid syndrome (APS), 1 had previous neurological manifestation and 1 had previous miscarriage. Disease characteristics, pregnancy features and investigated variables from the third trimester are reported in table 1.
Fibrinogen and D-dimer levels increased throughout pregnancies in SLE patients, while no differences were found compared to controls in the third trimester. OCP and OHP were significantly increased in SLE patients during the 3rd trimester of pregnancy, compared to HC (figure 1). However, in 2/8 SLE patients treated with LMWH, global hemostatic variables were undetectable, both were triple aPL positive and on therapeutic dosages of LMWH.
PE occurred in 4 SLE patients (18.2%); 2 were treated with LMWH (1 patient with APS with therapeutic and one aPL carrier with 1 prophylactic dosage). No thrombotic or major bleeding events occurred.
Conclusions All SLE patients displayed a hypercoagulable state throughout pregnancy, as demonstrated by the global hemostatic variables, except for two patients treated with therapeutic LMWH. Furthermore, in this pilot study almost 20% of pregnant women with SLE suffered PE despite ongoing LDASA prophylaxis. Larger longitudinal studies of hemostatic variables are needed to clarify the role of the procoagulant condition shown, and the benefits of thromboprophylactic treatment.
Acknowledgements The study was performed by grants provided by King Gustaf V:s memorial fund and ALF funding from Region Stockholm.
Levels of OCP, OHP and OFP in SLE patients during pregnancy and in comparison to controls. Red circles represent patients with preeclampsia. C- control pregnant women without preeclampsia, C+PE control pregnant women with preeclampsia, T1 – first trimester during pregnancy in SLE patients, T3 – third trimester during pregnancy in SLE patients. 25th and 75th percentile of reference range of respective variable in healthy non-pregnant individuals
Characteristics and coagulation parameters of SLE patients and HC. Continuous variables are expressed as mean±SD. g, i, I, n=p<0.05; a, b, c, d, e, f, h, m=p<0.01. (*) Prophylactic dose; (#) Anticoagulant dose. Abbreviations: aPL: antiphospholipid antibodies; APS: antiphospholipid syndrome; LDASA: low dose acetylsalicylic acid; LMWH: low molecular weight heparin; NA: not applicable; OCP: overall coagulation potential; OFP: overall fibrinolysis potential; OHP: overall haemostatic potential
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