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The clinical significance of D-dimer concentrations in patients with gestational hypertensive disorders according to the severity

대한산부인과학회지 2017년 60권 6호 p.542 ~ 548
김세정, 안효정, 박정연, 김병재, 황규리, 이택상, 전혜원, 김선민,
소속 상세정보
김세정 ( Kim Se-Jeong ) - Seoul National University Hospital Department of Obstetrics and Gynecology
안효정 ( Ahn Hyo-Jeong ) - Seoul National University Hospital Department of Obstetrics and Gynecology
박정연 ( Park Jung-Yeon ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
김병재 ( Kim Byoung-Jae ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
황규리 ( Hwang Kyu-Ri ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
이택상 ( Lee Taek-Sang ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
전혜원 ( Jeon Hye-Won ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
김선민 ( Kim Sun-Min ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology

Abstract


Objective: Pregnancy is a major risk factor of thromboembolism, and the patients with preeclampsia (PE) are known to have higher risk of thromboembolic complications than normal pregnant women. D-dimer is a well-established laboratory marker for the screening of venous thromboembolism (VTE), but the concentrations of d-dimer tend to increase physiologically in pregnant women throughout the gestational age. We performed this study to evaluate the clinical significance of d-dimer concentrations in patients with gestational hypertensive disorders (GHD) according to the severity.

Methods: Retrospective cohort study was performed in one institution. Singleton pregnant women with GHD were enrolled, and their antepartum concentrations of d-dimer were measured as a part of routine evaluation for patients suspected with PE. Patients with multiple gestations, rheumatic diseases, autoimmune diseases, or suspected VTE were excluded. A categorization of severity about PE was based on the general criteria.

Results: In 73.3% of study population, their d-dimer concentrations exceeded the normal range (>0.55 mg/L). A significantly greater proportion of pregnant women had excessive concentrations of d-dimer in the severe GHD than in the non-severe GHD (89.8% vs. 53.7%; P<0.01). Patients with severe GHD had significantly higher median concentrations of d-dimer than those with non-severe GHD (median [range], 2.00 mg/L [0.11 to 7.49] vs. 0.71 mg/L [0.09 to 5.39]; P<0.01) although their earlier gestational ages of sampling.

Conclusion: Maternal concentrations of d-dimer were significantly elevated in patients with severe features than those without severe features among those with GHD. Some pregnant women with GHD can have markedly elevated concentrations of d-dimer without any evidence of current VTE.

키워드

Hypertension; pregnancy-induced; Pre-eclampsia; Fibrin?fibrinogen degradation products; d-dimer; Pregnancy

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