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Association of antenatal antithrombin activity with perinatal liver dysfunction: A prospective multicenter study
Author(s) -
Morikawa Mamoru,
Suzuki Hirotada,
ObataYasuoka Mana,
Kasai Michi,
Itoh Hiroaki,
Ohkuchi Akihide,
Hamada Hiromi,
Aoki Shigeru,
Kanayama Naohiro,
Minakami Hisanori
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13714
Subject(s) - medicine , liver dysfunction , antithrombin , prospective cohort study , gestation , pregnancy , concomitant , hepatic dysfunction , gestational age , gastroenterology , obstetrics , heparin , biology , genetics
Background and Aim Liver dysfunction with decreased antithrombin (AT) activity and/or thrombocytopenia is life threatening in pregnant women. Whether AT is clinically useful for prediction of liver dysfunction remains unclear. Methods A total of 541 women were registered prospectively at gestational week 34.7 (20.0–41.4) with available data on antenatal AT and platelet count (PLC). Results Liver dysfunction defined as serum aspartate aminotransferase > 45 IU/L concomitant with lactate dehydrogenase > 400 IU/L occurred in five women antenatally (≤ 2 weeks before delivery) and in 17 women post‐partum (within 1 week post‐partum). Median (5th–95th) antenatal value was 85 (62–110)% for AT and 202 (118–315) × 10 9 /L for PLC in the 541 women and was significantly lower in women with than without perinatal liver dysfunction; 75 (51–108) versus 86 (62–110)% and 179 (56–244) versus 203 (121–316) × 10 9 /L, respectively. Nineteen (86%) women with liver dysfunction showed AT ≤ 62% or thrombocytopenia (PLC ≤ 118 × 10 9 /L) perinatally, but five lacked thrombocytopenia throughout the perinatal period. The best cut‐off (AT, 77%; PLC, 139 × 10 9 /L) suggested by receiver operating characteristic curve gave antenatal AT and PLC sensitivity of 59% and 41% with positive predictive value of 8.6% and 14%, respectively, and combined use of AT and PLC improved sensitivity to 73% (16/22) with positive predictive value of 9.2% for prediction of perinatal liver dysfunction. Conclusions Reduced AT not accompanied by thrombocytopenia can precede liver dysfunction. Clinical introduction of AT may enhance the safety of pregnant women.