TY - JOUR
T1 - Procoagulant imbalance in preterm neonates detected by thrombin generation procedures
AU - Tripodi, Armando
AU - Raffaeli, Genny
AU - Scalambrino, Erica
AU - Padovan, Lidia
AU - Clerici, Marigrazia
AU - Chantarangkul, Veena
AU - Cavallaro, Giacomo
AU - Peyvandi, Flora
AU - Mosca, Fabio
AU - Ghirardello, Stefano
PY - 2020/1
Y1 - 2020/1
N2 - Preterm newborns are considered at risk of acquired coagulopathy and are often prophylactically infused with fresh frozen plasma (FFP) even in the absence of bleeding. To assess the coagulation asset of preterm neonates and the biological plausibility of such infusions, we investigated at birth 87 very low birth weight (≤1500 g) preterm (gestational age <35 weeks) newborns and 64 full-term newborns. Preterm neonates were also investigated at different time-points up to 30 days after birth. Plasma from preterm and full-term neonates were subjected to the measurement of prothrombin and activated partial thromboplastin time (PT, APTT), pro- and anticoagulant factors as well as to thrombin-generation procedures both with and without thrombomodulin. PT and APTT of preterm newborns were longer than those of full-term neonates [PT: 15.9 s (11.7–51.2)-vs-13.8 (11.0–25.4), p < 0.001. APTT: 59.0 (37.8–97.5)-vs- 47.3 (28.1–71.9), p < 0.001] and tended to shortening after 30 days from birth. Thrombin-generation defined as endogenous thrombin potential (ETP) was increased in preterm as compared to full-term neonates at birth [1322 nM·min (474–2384)-vs-1006 (697–1612), p < 0.001] and did not change appreciably over time up to 30 days from birth. In conclusion, plasma from preterm neonates displays a procoagulant imbalance at birth as shown by increasing ETP, despite the prolongation of PT and APTT. The results define preterm newborns as having hyper- rather than hypo-coagulability and argue against the infusion of FFP when given prophylactically and/or based solely on prolongation of PT or APTT.
AB - Preterm newborns are considered at risk of acquired coagulopathy and are often prophylactically infused with fresh frozen plasma (FFP) even in the absence of bleeding. To assess the coagulation asset of preterm neonates and the biological plausibility of such infusions, we investigated at birth 87 very low birth weight (≤1500 g) preterm (gestational age <35 weeks) newborns and 64 full-term newborns. Preterm neonates were also investigated at different time-points up to 30 days after birth. Plasma from preterm and full-term neonates were subjected to the measurement of prothrombin and activated partial thromboplastin time (PT, APTT), pro- and anticoagulant factors as well as to thrombin-generation procedures both with and without thrombomodulin. PT and APTT of preterm newborns were longer than those of full-term neonates [PT: 15.9 s (11.7–51.2)-vs-13.8 (11.0–25.4), p < 0.001. APTT: 59.0 (37.8–97.5)-vs- 47.3 (28.1–71.9), p < 0.001] and tended to shortening after 30 days from birth. Thrombin-generation defined as endogenous thrombin potential (ETP) was increased in preterm as compared to full-term neonates at birth [1322 nM·min (474–2384)-vs-1006 (697–1612), p < 0.001] and did not change appreciably over time up to 30 days from birth. In conclusion, plasma from preterm neonates displays a procoagulant imbalance at birth as shown by increasing ETP, despite the prolongation of PT and APTT. The results define preterm newborns as having hyper- rather than hypo-coagulability and argue against the infusion of FFP when given prophylactically and/or based solely on prolongation of PT or APTT.
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U2 - 10.1016/j.thromres.2019.11.013
DO - 10.1016/j.thromres.2019.11.013
M3 - Article
C2 - 31786478
AN - SCOPUS:85075524509
VL - 185
SP - 96
EP - 101
JO - Thrombosis Research
JF - Thrombosis Research
SN - 0049-3848
ER -