https://onlinelibrary.wiley.com/doi/epdf/10.1111/jth.14882

Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH.

Preterm newborns are at thrombohemorrhagic risk during the early neonatal period. Taking into account the lack of informative tools for the laboratory diagnosis of hemostasis disorders in newborns, our goal was to determine the baseline values of thrombodynamics and platelet functional activity in healthy term and moderately preterm newborns during the early neonatal period future potential clinical use of these tests. Coagulation was assessed using an integral assay of thrombodynamics and standard coagulation assays, and platelet functional activity was estimated by flow cytometry. Hypercoagulation of newborns, represented by a significantly higher clot growth velocity and the presence of spontaneous clots in the thrombodynamics, was combined with platelet hypoactivity. Granule release, phosphatidylserine exposure, and the ability to change shape upon activation were decreased in the platelets of moderately preterm newborns. The platelet function remained at the same level over the first four days of life, whereas the hypercoagulation became less pronounced. The hemostasis of newborns is characterized by hypercoagulation combined with reduced platelet functional activity. Moderately preterm and term newborns do not differ in the parameters of coagulation, while some of the functional responses of platelets are lower in moderately preterm newborns than in term.

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Impaired platelet activity and hypercoagulation in healthy term and moderately preterm newborns during the early neonatal period.

Alterations in the parameters of classic, global, and innovative assays of hemostasis caused by sample transportation via pneumatic tube system.

Background 
The shift towards hypercoagulation during in vitro fertilization (IVF) can lead to the impairment of embryo implantation and placental blood circulation, which is believed to be a factor in an unsuccessful IVF cycle.


Objectives 
To assess coagulation in women with infertility before the start of an IVF cycle and during treatment to reveal the association between coagulation imbalance and IVF outcome.


Patients/Methods 
We conducted a prospective cohort observational study including 125 participants who underwent fresh IVF cycles. Blood samples were collected at five time points: before IVF, one week after the start of controlled ovarian stimulation (COS), on the day of follicular puncture, on the day of embryo transfer (ET) and one week after ET. Coagulation tests (clotting times: activated partial thromboplastin time (APTT) and prothrombin; fibrinogen and D-dimer concentrations; thrombodynamics) were performed.


Results 
Women with an elevated clot growth velocity (>32.3 μm/min, detected by thrombodynamics) before IVF demonstrated a higher risk of negative IVF outcomes (adjusted RR = 1.38; 95% CI 1.28–1.49; P<0.001). During the procedure, we observed increases in prothrombin, fibrinogen and D-dimer concentrations, a slight shortening of APTT and a hypercoagulation shift in the thrombodynamics parameters. The hemostasis assay values during COS and after ET had no associations with IVF outcomes.


Conclusions 
Hypercoagulation in the thrombodynamics before the start of IVF treatment was associated with negative IVF outcomes. After the start of COS, all tests demonstrated a hypercoagulation trend, but the hypercoagulation did not influence IVF outcome. This research is potentially beneficial for the application of thrombodynamics assay for monitoring hemostasis in infertile women prior to an IVF procedure with the goal of selecting a group requiring hemostasis correction to increase the chances of pregnancy.

An enhanced clot growth rate before in vitro fertilization decreases the probability of pregnancy.

Newborns have high risks of thrombotic and hemorrhagic complications. Despite the fact that the overall frequency of thrombosis and bleeding in the general population of neonates is low, the risks of both thrombosis and hemorrhage are significantly increased when a newborn has some complications, including prematurity. The mechanisms underlying the onset of thrombotic and hemorrhagic complications in newborns are not fully understood and remain controversial. The hemostasis in newborns drastically differs from adult hemostasis and even from hemostasis in children older than a year. Nevertheless, despite the presence of quantitative and qualitative differences of almost all parameters of the hemostasis system from the parameters of adults, healthy newborns as a whole have clinically normal functional hemostasis without a tendency to coagulopathy or thrombosis. Apparently, the neonatal hemostasis system is in some alternative "balance", which differs from the "balance" of hemostasis in adults. The issue regarding the stability of this balance is still open. Due to the peculiarities of the newborn's hemostasis, clinical laboratory diagnostics of the coagulation disorders is very difficult, and the attending physician is forced to focus exclusively on the clinical picture. This review provides basic information on the neonatal hemostasis system, as well as an attempt to critically evaluate existing laboratory tests in terms of applicability for this group of patients.

https://www.hemoncim.com/jour/article/download/219/226

Лабораторные аспекты гемостаза новорожденных

Introduction The incidence of venous thromboembolism (VTE) after cesarean section is up to 06%, and the widespread use of cesarean section draws attention to this group The dosage and duration of low-molecular-weight heparin (LMWH) prophylaxis after delivery is estimated by anamnestic risk-scales; however, the predictive potency for an individual patient's risk can be low Laboratory hemostasis assays are expected to solve this problem The aim of this study was to estimate the potency of tests to reflect the coagulation state of patients receiving LMWH in the early postpartum period Materials and methods We conducted an observational study on 97 women undergoing cesarean section Standard coagulation tests (Fg, APTT, prothrombin, D-dimer), an anti-Xa assay, rotation thromboelastometry and thrombodynamics/thrombodynamics-4D were performed Coagulation assay parameters were compared in groups formed in the presence or absence of LMWH to estimate the laboratory assays' sensitivity to anticoagulation Results Coagulation assays revealed hypercoagulation after delivery and a tendency toward normalization of coagulation during early postpartum The thromboprophylaxis results revealed a higher percentage of coagulation parameters within the normal range in the LMWH group Conclusion This research is potentially beneficial for the application of thrombodynamics and thrombodynamics-4D in monitoring coagulation among patients with high VTE risk who receive thromboprophylaxis with heparin

Konstantin I Grischuk

Papers

The laboratory control of anticoagulant thromboprophylaxis during the early postpartum period after cesarean delivery.