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Maternal and pregnancy characteristics affect plasma fibrin monomer complexes and D-Dimer reference ranges for venous thromboembolism in pregnancy

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Karin B. Grossman, Roopen Arya, Alberto B. Peixoto, Ranjit Akolekar, Ismini Staboulidou, Kypros H. Nicolaides

Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
Early online date11 May 2016
DOIs
Publication statusE-pub ahead of print - 11 May 2016

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Abstract

AbstractBackground D-dimers have a high negative predictive value for excluding venous thromboembolism outside of pregnancy but the use in pregnancy remains controversial. A higher cut-off value has been proposed in pregnancy due to a continuous increase across gestation. Fibrin monomer complexes have been considered as an alternative diagnostic tool for exclusion of VTE in pregnancy due to their different behaviour. Objective To establish normal values of Fibrin monomer complexes and D-dimer as a diagnostic tool for the exclusion of VTE in pregnancy and examine the effect of maternal and obstetric factors on these markers. Study Design Plasma D-dimer and fibrin monomer complexes were measured by quantitative immunoturbidimetry in 2870 women with singleton pregnancies attending for their routine first trimester hospital visit in a prospective screening study for adverse obstetric outcome. Multiple regression analysis was used to determine maternal characteristics and obstetric factors affecting the plasma concentrations and converting these into multiple of the median values after adjusting for significant maternal and obstetric characteristics. Results Plasma fibrin monomer complexes increased with maternal weight and were lower in women with a history of cocaine abuse and chronic hypertension.D-dimers increased with gestational age and maternal weight and were higher in sickle cell carriers and in women of African and South Asian racial origin compared to Caucasians. Conclusions Fibrin monomer complexes and D-dimers are affected by maternal and obstetric characteristics rather than only gestational age. The utility of these fibrin-linked markers as a tool for exclusion of venous thromboembolism in pregnancy might be improved by adjusting for patient specific characteristics.

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