Procoagulant imbalance in preterm neonates detected by thrombin generation procedures. Issue 185 (January 2020)

• Record Type: Journal Article
• Authors: Tripodi, Armando; Raffaeli, Genny; Scalambrino, Erica; Padovan, Lidia; Clerici, Marigrazia; Chantarangkul, Veena; Cavallaro, Giacomo; Peyvandi, Flora; Mosca, Fabio; Ghirardello, Stefano
• Is Part Of: Thrombosis research. Issue 185(2020)
• Page Start: 96
• Page End: 101
• Publication Date: 2020-01
• Subjects: Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.11.013
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: 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. Highlights: Thrombin generation in neonates is rebalanced because of the concomitant deficiency of pro- and anticoagulants, despite the prolongation of PT/APTT Scanty observations are available for preterm neonates at birth and during the first month of life. Thrombin generation in preterm neonates is higher than that in full-term neonates at birth. Thrombin generation in preterm neonates remains high until the first month of life. In the absence of bleeding, the prophylactic infusion of fresh frozen plasma to correct prolonged PT and APTT is not biologically plausible.