Prediction and prevention of venous thrombosis in pregnancy

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dc.check.embargoformatBoth hard copy thesis and e-thesisen
dc.check.entireThesisEntire Thesis Restricted
dc.check.opt-outNot applicableen
dc.check.reasonThis thesis is due for publication or the author is actively seeking to publish this materialen
dc.contributor.advisorHiggins, John R.en
dc.contributor.advisorNorris, Lucyen
dc.contributor.authorIsmail, Siti Khadijah
dc.contributor.funderANU Research Centre, College of Medicine and Health, University College Corken
dc.date.accessioned2013-07-16T09:07:33Z
dc.date.issued2013
dc.date.submitted2013
dc.description.abstractVenous thromboembolism (VTE) remains the leading cause of maternal mortality. Reports identified further research is required in obese and women post caesarean section (CS). Risk factors for VTE during pregnancy are periodically absent indicating the need for a simple and effective screening tool for pregnancy. Perturbation of the uteroplacental haemostasis has been implicated in placenta mediated pregnancy complications. This thesis had 4 main aims: 1) To investigate anticoagulant effects following a fixed thromboprophylaxis dose in healthy women post elective CS. 2) To evaluate the calibrated automated thrombogram (CAT) assay as a potential predictive tool for thrombosis in pregnancy. 3) To compare the anticoagulant effects of fixed versus weight adjusted thromboprophylaxis dose in morbidly obese pregnant women. 4) To investigate the LMWH effects on human haemostatic gene and antigen expression in placentae and plasma from the uteroplacental , maternal and fetal circulation. Tissue factor pathway inhibitor (TFPI), thrombin antithrombin (TAT), CAT and anti-Xa levels were analysed. Real-time PCR and ELISA were used to quantify mRNA and protein expression of TFPI and TF in placental tissue. In women post CS, anti-Xa levels do not reflect the full anticoagulant effects of LMWH. LMWH thromboprophylaxis in this healthy cohort of patients appears to have a sustained effect in reducing excess thrombin production post elective CS. The results of this study suggest that predicting VTE in pregnant women using CAT assay is not possible at present time. The prothrombotic state in pregnant morbidly obese women was substantially attenuated by weight adjusted but not at fixed LMWH doses. LMWH may be effective in reducing in- vivo thrombin production in the uteroplacental circulation of thrombophilic women. All these results collectively suggest that at appropriate dosage, LMWH is effective in attenuating excess thrombin generation, in low risk pregnant women post caesarean section or moderate to high risk pregnant women who are morbidly obese or tested positive for thrombophilia. The results of the studies provided data to inform evidence-based practice to improve the outcome for pregnant women at risk of thrombosis.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationIsmail, S.K. 2013. Prediction and prevention of venous thrombosis in pregnancy. PhD Thesis, University College Cork.en
dc.identifier.endpage242
dc.identifier.urihttps://hdl.handle.net/10468/1176
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2013, Siti Khadijah Ismail.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectVenous thromboembolismen
dc.subjectPregnancy and haemostasisen
dc.subjectLow molecular weight heparinen
dc.subjectUteroplacental haemostasisen
dc.subjectHaemostasis in obese pregnancyen
dc.subject.lcshHemostasisen
dc.subject.lcshThromboembolismen
dc.subject.lcshThrombosisen
dc.subject.lcshHeparinen
dc.subject.lcshBlood coagulation disorders in pregnancyen
dc.subject.lcshBlood diseases in pregnancyen
dc.thesis.opt-outfalse*
dc.titlePrediction and prevention of venous thrombosis in pregnancyen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD (Medicine and Health)en
ucc.workflow.supervisorcora@ucc.ie*
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