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Fibrinolysis in pregnancy: a study of plasminogen activator inhibitors
EK Kruithof, C Tran-Thang, A Gudinchet, J Hauert, G Nicoloso, C Genton, H Welti and F Bachmann
During pregnancy the plasma concentration of two different inhibitors of
plasminogen activators (PAIs) increases. The only one found in the plasma
of nonpregnant women (PAI1) is immunologically related to a PAI of
endothelial cells; its plasma activity, as deduced from the inhibition of
single-chain tissue-type plasminogen activator (t-PA), increased from 3.4
+/- 2.3 U/mL (mean +/- 95% confidence limits) in the plasma of nonpregnant
women to 29 +/- 7 U/mL at term, and its antigen level, measured by a
radioimmunoassay, increased from 54 +/- 17 ng/mL to 144 +/- 25 ng/mL. In
pregnancy plasma a second PAI (PAI 2) related to a PAI found in placenta
extracts was observed. Its level, quantified with a radioimmunoassay,
increased from below the detection limit (approximately 10 ng/mL) in normal
plasma to 260 ng/mL at term. One hour after delivery, PAI 1 activities and
antigen decreased sharply, but the PAI 2 antigen levels remained constant.
Three days later, the PAI 1 antigen levels had fallen to normal levels, but
the PAI 2 antigen levels were still at least eightfold above the
nonpregnant values. During pregnancy, the t-PA and prourokinase (u-PA)
antigen concentrations increased 50% and 200%, respectively, whereas the
plasminogen and alpha 2-antiplasmin levels remained constant. Despite the
large variations in the levels of PAs and PAIs, the overall fibrinolytic
activity as measured in diluted plasma by a radioiodinated fibrin plate
assay did not change significantly. Just after delivery, a great increase
in the t-PA antigen levels was observed. Three to five days after delivery
most parameters of the fibrinolytic system were normal again. Our results
demonstrate that during pregnancy and in the puerperium profound
alterations of the fibrinolytic system occur that are characterized by
increases in PAs and their inhibitors, but these alterations do not affect
the overall fibrinolytic activity.
Volume 69,
Issue 2,
pp. 460-466,
02/01/1987
Copyright © 1987 by The American Society of Hematology
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