PB0598 - Primary role in assessing the risk of severe early onset preeclampsia of phospholipid-dependent procoagulant clotting time and initiation phase of thrombin generation test

Background: Pathogenesis of preeclampsia is characterized by abnormal placental vascular intact antithrombotic properties of the endothelial cells and efficient regulation of thrombin generation and platelet activation at the microenvironment of the uterus are necessary conditions for successful trophoblast invasion and development of feto-maternal circulation during normal pregnancy

Aims: The ROADMAP-Early Onset Preeclampsia study aiming to respond to this unmet need assessed the clinical relevance of biomarkers of hypercoagulability and endothelial activation for prompt identification of pregnant women at high risk of preeclampsia

Methods: : Pregnant women were retrospectively enrolled upon EOP diagnosis and stratified in mild EOP group and severe EOP group. Thrombin generation (TG), tissue factor activity (TFa), Procoagulant phospholipid (PPL), Proteins S, TFPI, D-dimer, antithrombin, thrombomodulin,were measured. Principal component analysis was performed to check for associations among the biomarkers and the clinical out-come.

Results: Platelet counts were similar in healthy pregnant women, and mild EOP group, and significantly lower in severe EOP (p < 0.05). When biomarkers were considered according to the severity of EOP in PCA analysis the lag-time and PPL clotting time were independently associated with the risk of severe EOP (Table 1and Figure 1). The increase of the lag-time by 1 min was associated with a 20.2-fold increase of the risk of severe EOP. Longer Procoag-PPL clotting time was associated with lower risk of severe EOP. The marginal effects curve, showed that for Procoag-PPL clotting time longer than 58.75 sec the probability of severe EOP decreased by 50%.These data suggest that a biological score composed of the PPL and TG could be a useful tool to identify pregnant women with high probability of EOP (table 1; fig 1)

Conclusion(s): The PPL and thrombin generation reflect cellular derived hypercoagulability and allow accurate screening of pregnant women for the prompt identification of those at risk of EOP and the evaluation of its severity.