Fibrinolysis after an Elective Caesarean Section without Postpartum Hemorrhage: Pilot Study for Reference Values from the Simultaneous Thrombin and Plasmin Generation Assays
Authors:   Obstetric Anesthesia and Intensive Care Unit, Jeanne de Flandre Women’s Hospital, Lille University Medical Center, Lille, France, S Ducloy-Bouthors A , F Lassalle ,   Hemostasis Unit, Biology and Pathology Center, Lille University Medical Center, Lille, France, S Gilliot ,   University of Lille, ULR 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France, M Kyheng ,   University of Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France, R Favier ,   Hemostasis Unit, Hematological Laboratory, Armand Trousseau Children’s Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France, E Peynaud ,   Hemostasis Unit, Hematological Laboratory, Louis Mourrier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France, C Hémar ,   Hemostasis Unit, Hematological Laboratory, Valenciennes General Hospital, Valenciennes, France, B Hennart ,   Toxicology Unit, Biology and Pathology Center, Lille University Medical Center, Lille, France, A Turbelin ,   Obstetric Anesthesia and Intensive Care Unit, Jeanne de Flandre Women’s Hospital, Lille University Medical Center, Lille, France, G Lebuffe ,   Obstetric Anesthesia and Intensive Care Unit, Jeanne de Flandre Women’s Hospital, Lille University Medical Center, Lille, France, A Duhamel ,   CHU Lille, Département de Biostatistiques, Lille, France, S Susen ,   Hemostasis Unit, Biology and Pathology Center, Lille University Medical Center, Lille, France, E Jeanpierre ,   Hemostasis Unit, Biology and Pathology Center, Lille University Medical Center, Lille, France, P Odou ,   University of Lille, ULR 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
Published: May 2021

ntroduction: Postpartum Hemorrhage (PPH)-induced coagulopathy should be better explored. An innovative Simultaneous Generation of Thrombin and Plasmin Assay (SGTPA) was developed. Objective: To establish postpartum SGTPA references. Methods: Blood samples collected immediately after delivery (T0) and then 30, 60, 120 and 360 minutes later. Thrombin Generation (TG) and Plasmin Generation (PG) changes over time analyzed in 51 women after elective cesarean section without PPH and compared with Non-Pregnant (NP) women. The SGTPA variables’ correlations with fibrinogen levels, D-dimer levels and physiological blood loss were assessed in a mixed model. Results: 37 women were included. TG and PG were higher in the postpartum group than in the NP group. TG increased early and then remained stable (baseline TG Area Under the Curve (AUC) [95% Confidence Interval (CI)] = 41037 [36850-43537] nM.min). The fibrinogen level varied over time, along with TG (p<0.001). Plasmin generation increased from 30 to 120 minutes (AUC [95% CI]: 2104 [1437; 2613] nM.min), along with a change in the D-dimer level (p=0.018). The time to the plasmin peak and the time interval between the TG and PG peaks showed the greatest inter-individual variability at T0 and were associated with physiological volumes of blood loss during cesarean delivery. Conclusion: Reference SGTPA postpartum range was established. The SGTPA appears to be valuable for measuring TG and PG. TG and coagulation activation increased immediately after delivery, whereas PG and fibrinolysis increased later.