56 The anticoagulant action of heparin is not completely understood. Presumably heparin interferes at several stages with the coagulation.22 Eika et al.23 found that as little as 0003-001 units of heparin per ml blood prolonged the thrombin-time. Biggs et al. 24 and Wessler and Yin25 have suggested that low levels of heparin enhance the effect of naturally occurring inhibitors of activated factor X (anti-Xa). Yin et al .26 have demonstrated that heparin together with factor Xa inhibitor forms a potent antiplatelet-aggregant. Considering the results, it appears that low-dose heparin treatment may shorten the period of post-,
operative hypoxaemia, probably by counteracting both large pulmonary emboli, as shown previously, and microthromboembolism. REFERENCES 1. Kakkar, V. V. Circulation, 1975, 51, 8. 2. Price, H. L. Physiol. Rev. 1960, 46, 187. 3. Werkö, L. Acta med. scand. 1947, suppl. 47. 4. McLachlin, A., McLachlin, J., Jory, A., Rawling, E. Ann. Surg. 1960, 152, 678. 5. Lahnborg, G., Bergström, K. Acta chir. scand. (in the press). 6. Kakkar, V. V., Field, E. S., Nicolaides, A. N., Flute, P. T., Wessler, S., Yin, E. T. Lancet, 1971, ii, 669. 7. Gordon-Smith, I. C., Grundy, D. J., Le Quesne, L. P., Newcombe, J. F., Bramble, F. J. ibid. 1972, i, 1132. 8. Gallus, A. S., Hirsh, J., Tuttle, R. J., Trebilcock, R., O’Brien, S. E., Carrol, J. J., Mindin, J. H., Hudecki, M. New Engl. J. Med. 1973, 288, 11. 9. Sharnoff, G. J., DeBlasio, G. Lancet, 1970, ii, 1006. 10. Lahnborg, G., Bergström, K., Friman, L., Lagergren, H. ibid. 1974, i, 329. 11. Modig, J., Busch, C., Olerud, S., Saldeen, R., Waernbaum, G. Acta anœsth. scand. 1975, 19, 28. 12. Overholt, R. H. J. Am. med. Ass. 1930, 95, 1484. 13. Anscombe, A. R. Pulmonary Complications of Abdominal Surgery. London, 1957. 14. Schlosser, D. Langenbecks Arch. Chir. 1972, 330, 348. 15. Campbell, E. J. M. The Respiratory Muscles and the Mechanics of Breath-
ing. London, 1958. J. I., Spence,
A. A., Parikh, R. K., Stuart, B. Br. J. Anœsth. 1973, 45, 34. 17. Bevan, P. G. Br. J. Surg. 1961, 49, 126. 18. Carlsten, A., Nordlander, O., Troell, L. Surgery Gynec. Obstet. 1954, 99,
16. Alexander,
227. 19. Bayley, T., Clements, J. A., Osbahr, A. J. Circul. Res. 1967, 21, 469. 20. Palmer, M. A., Piper, P. J., Vane, J. R. Br. J. Pharmac. 1970, 40, 547. 21. Rådegran, K. Acta. anœsth. scand. 1972, 16, 140. 22. Koller, F. Thromb. Diath. Hœmorrh. 1974, 33, 17. 23. Eika, C., Godal, H. C., Kierulf, P. Lancet, 1972, ii, 376. 24. Biggs, R., Denson, N. W. W., Akman, N., Borett, R., Hadden, M. Br. J. Hœmat. 1970, 19, 283. 25. Wessler, S., Yin, T. E. Circulation 1973, 47, 671. 26. Yin, T. E., Giudice, L. C., Wessler, S. Paper presented to the IVth International Congress on Thrombosis and Hæmostasis, Vienna, 1973.
SOLUBLE
FIBRINOGEN/FIBRIN COMPLEXES IN PRE-ECLAMPSIA
CAROLINE MCKILLOP C. D. FORBES
P. W. HOWIE C. R. M. PRENTICE
University Department of Medicine, Glasgow Royal Infirmary, and University Department of Obstetrics, Royal Maternity Hospital, Glasgow
Summary
Significantly of soluble
increased
concentrations
fibrinogen/fibrin complexes
found in plasma samples from ten normal pregnant women when compared with ten non-pregnant agematched controls. In ten women with pre-eclampsia mean soluble complex concentration was more than three times that in the age, parity, and gestation matched pregnant controls. Soluble fibrinogen/fibrin complexes are also found in the plasma of patients in were
various hypercoagulable and thrombotic states, including disseminated intravascular coagulation. These findings provide additional evidence that pre-eclampsia is associated with disseminated intravascular coagulation.
Introduction THERE is histological evidence of fibrin deposition on the vascular endothelium in cases of severe pre-eclampsia,l2 and in addition there are changes in both the blood-coagulation and fibrinolytic systems, which are significantly greater than those occurring in normal pregnancy.3-5 These features suggest that disseminated intravascular coagulation (D.I.C.) is associated with preeclampsia. Soluble complexes of fibrinogen/fibrin-related antigen (F.R. antigen) were found in plasma samples from- patients with various hypercoagulable and thrombotic conditions6 ’and were demonstrated in the plasma of a patient with severe eclampsia and coma associated with the coagulation changes of D.LC.8 This study was undertaken to see whether soluble complexes could be detected in pre-eclampsia.
Patients, Materials,
and Methods
Three groups were studied-ten patients with pre-eclampsia (group i), ten normal, pregnant women (group II), and ten normal, non-pregnant women (group III). Pre-eclampsia was diagnosed in patients developing hypertension, with a diastolic blood-pressure greater than 90 mm Hg on at least two occasions, and proteinuria in excess of 0.5 g per 24 hours. All patients were normotensive and did not have detectable proteinuria at their first antenatal visit. The signs developed after the 24th week of pregnancy and resolved after delivery. The two pregnant groups were matched for age, parity, and gestation. When the plasma samples were taken the diastolic blood-pressure was 101±9 mm Hg (mean±1 S.D.) in Proteinuria groupand 73+_8 mm Hg in group ii (P
operative hypoxaemia, probably by counteracting both large pulmonary emboli, as shown previously, and microthromboembolism. REFERENCES 1. Kakkar, V. V. Circulation, 1975, 51, 8. 2. Price, H. L. Physiol. Rev. 1960, 46, 187. 3. Werkö, L. Acta med. scand. 1947, suppl. 47. 4. McLachlin, A., McLachlin, J., Jory, A., Rawling, E. Ann. Surg. 1960, 152, 678. 5. Lahnborg, G., Bergström, K. Acta chir. scand. (in the press). 6. Kakkar, V. V., Field, E. S., Nicolaides, A. N., Flute, P. T., Wessler, S., Yin, E. T. Lancet, 1971, ii, 669. 7. Gordon-Smith, I. C., Grundy, D. J., Le Quesne, L. P., Newcombe, J. F., Bramble, F. J. ibid. 1972, i, 1132. 8. Gallus, A. S., Hirsh, J., Tuttle, R. J., Trebilcock, R., O’Brien, S. E., Carrol, J. J., Mindin, J. H., Hudecki, M. New Engl. J. Med. 1973, 288, 11. 9. Sharnoff, G. J., DeBlasio, G. Lancet, 1970, ii, 1006. 10. Lahnborg, G., Bergström, K., Friman, L., Lagergren, H. ibid. 1974, i, 329. 11. Modig, J., Busch, C., Olerud, S., Saldeen, R., Waernbaum, G. Acta anœsth. scand. 1975, 19, 28. 12. Overholt, R. H. J. Am. med. Ass. 1930, 95, 1484. 13. Anscombe, A. R. Pulmonary Complications of Abdominal Surgery. London, 1957. 14. Schlosser, D. Langenbecks Arch. Chir. 1972, 330, 348. 15. Campbell, E. J. M. The Respiratory Muscles and the Mechanics of Breath-
ing. London, 1958. J. I., Spence,
A. A., Parikh, R. K., Stuart, B. Br. J. Anœsth. 1973, 45, 34. 17. Bevan, P. G. Br. J. Surg. 1961, 49, 126. 18. Carlsten, A., Nordlander, O., Troell, L. Surgery Gynec. Obstet. 1954, 99,
16. Alexander,
227. 19. Bayley, T., Clements, J. A., Osbahr, A. J. Circul. Res. 1967, 21, 469. 20. Palmer, M. A., Piper, P. J., Vane, J. R. Br. J. Pharmac. 1970, 40, 547. 21. Rådegran, K. Acta. anœsth. scand. 1972, 16, 140. 22. Koller, F. Thromb. Diath. Hœmorrh. 1974, 33, 17. 23. Eika, C., Godal, H. C., Kierulf, P. Lancet, 1972, ii, 376. 24. Biggs, R., Denson, N. W. W., Akman, N., Borett, R., Hadden, M. Br. J. Hœmat. 1970, 19, 283. 25. Wessler, S., Yin, T. E. Circulation 1973, 47, 671. 26. Yin, T. E., Giudice, L. C., Wessler, S. Paper presented to the IVth International Congress on Thrombosis and Hæmostasis, Vienna, 1973.
SOLUBLE
FIBRINOGEN/FIBRIN COMPLEXES IN PRE-ECLAMPSIA
CAROLINE MCKILLOP C. D. FORBES
P. W. HOWIE C. R. M. PRENTICE
University Department of Medicine, Glasgow Royal Infirmary, and University Department of Obstetrics, Royal Maternity Hospital, Glasgow
Summary
Significantly of soluble
increased
concentrations
fibrinogen/fibrin complexes
found in plasma samples from ten normal pregnant women when compared with ten non-pregnant agematched controls. In ten women with pre-eclampsia mean soluble complex concentration was more than three times that in the age, parity, and gestation matched pregnant controls. Soluble fibrinogen/fibrin complexes are also found in the plasma of patients in were
various hypercoagulable and thrombotic states, including disseminated intravascular coagulation. These findings provide additional evidence that pre-eclampsia is associated with disseminated intravascular coagulation.
Introduction THERE is histological evidence of fibrin deposition on the vascular endothelium in cases of severe pre-eclampsia,l2 and in addition there are changes in both the blood-coagulation and fibrinolytic systems, which are significantly greater than those occurring in normal pregnancy.3-5 These features suggest that disseminated intravascular coagulation (D.I.C.) is associated with preeclampsia. Soluble complexes of fibrinogen/fibrin-related antigen (F.R. antigen) were found in plasma samples from- patients with various hypercoagulable and thrombotic conditions6 ’and were demonstrated in the plasma of a patient with severe eclampsia and coma associated with the coagulation changes of D.LC.8 This study was undertaken to see whether soluble complexes could be detected in pre-eclampsia.
Patients, Materials,
and Methods
Three groups were studied-ten patients with pre-eclampsia (group i), ten normal, pregnant women (group II), and ten normal, non-pregnant women (group III). Pre-eclampsia was diagnosed in patients developing hypertension, with a diastolic blood-pressure greater than 90 mm Hg on at least two occasions, and proteinuria in excess of 0.5 g per 24 hours. All patients were normotensive and did not have detectable proteinuria at their first antenatal visit. The signs developed after the 24th week of pregnancy and resolved after delivery. The two pregnant groups were matched for age, parity, and gestation. When the plasma samples were taken the diastolic blood-pressure was 101±9 mm Hg (mean±1 S.D.) in Proteinuria groupand 73+_8 mm Hg in group ii (P
