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Neurologic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Robert Burger, Terry Rolan, David Lardizabal, Upinder Dhand, Aarti Sarwal, Pradeep Sahota
Pregnancy is a relatively hypercoagulable state with markedly increased levels of fibrinogen, total body, and plasma levels of factors VII, X, and XII. The increased activity of factors of hemostasis is accompanied by an increase in activity and concentration of ATIII and acquired activated protein C resistance predisposing to thromboembolic events (90).
Combined hormonal contraception
Published in John Guillebaud, Contraception Today, 2019
Genetic predispositions are rare, but when known are all classified as UKMEC 4. The most common is factor V Leiden, the genetic cause of activated protein C resistance. Even if all test results are found to be normal, however, the COC remains categorized UKMEC 3 by the family history alone (see Table 5). The woman's strong family history cannot be discounted because by no means have all the predisposing abnormalities of the complex haemostatic system yet been characterized. This is why even targeted screening by any blood test is not justifiable – the cost would be prohibitive and, in terms of what matters, which is the occurrence of actual disease events, there are just too many false-negative and false-positive results. The exception a haematologist may make is for a woman, desperate to use a CHC rather than say a LARC, who has a symptomatic near relative with a very high-risk hereditary thrombophilia: its exclusion by testing may allow the use of a CHC.
Analysis and Interpretation
Published in John M. Wayne, Cynthia A. Schandl, S. Erin Presnell, Forensic Pathology Review, 2017
John M. Wayne, Cynthia A. Schandl, S. Erin Presnell
Answer B is incorrect. Factor V Leiden (fVL) is an abnormal coagulation factor due to an autosomal dominant genetic abnormality, most commonly replacement of the critical arginine amino acid with a glutamine at protein position 506. Heterozygously affected individuals have an approximately four to eight times greater likelihood of developing venous thrombosis, while the risk of homozygously affected individuals is as high as 80-fold. The abnormal factor V leads to activated protein C resistance. APC cannot cleave fVL and leads to continued presence of an active clotting factor and to insufficient production of the anticoagulant factor Vac, which is a cofactor in APC-mediated cleavage of another procoagulant, factor VIIIa (also see Van Cott EM, Khor B, Zehnder JL. Factor V Leiden. Am J Hematol 2016, 91[1]: 46–9).
Activated protein C resistance impact on Syrian candidates for in vitro fertilisation and the benefit of anticoagulation therapy: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Rami Sabouni, Maarouf Gorra Al Nafouri, Ibrahem Hanafi, Ismael Al Droubi, Marwan Alhalabi
Activated protein C resistance (APCR) is a common thrombophilia, with a worldwide prevalence of 10%–15% (Winkler 2019). It causes a thrombophilic state due to the resistance against activated protein C anticoagulant properties. People with this condition lack the normal function of activated protein C pathway (Nicolaes and Dahlbäck 2003). APCR causes are classified into inherited and acquired, and the most common inherited mutation is factor five Leiden (FVL). The latter is due to a single point mutation in factor V, which replaces Arg506 with Glu residue (Nichols and Heit 1996). FVL represents more than 90% of APCR inherited causes (Nichols and Heit 1996), while the acquired causes of APCR include cancer (Sarig et al. 2005), pregnancy, hormone replacement therapy, and oral contraceptives (Curvers et al. 2002).
The impact of micronized progesterone on cardiovascular events – a systematic review
Published in Climacteric, 2022
L. M. Kaemmle, A. Stadler, H. Janka, M. von Wolff, P. Stute
These reported neutral effects of MP in combined MHT on vascular events has been supported by studies addressing vascular surrogate markers. For example, some of the included studies also assessed such parameters showing neutral effects of combined MHT containing MP on body weight, blood pressure (KEEPS [16], ELITE [14], PEPI [23]), and a significantly lowering effect on fasting serum glucose compared to placebo [16,23]. The latter finding has been supported by a systematic review [30]. In respect to serum lipids, PEPI reported the most favorable effect on high-density lipoprotein-cholesterol for combined MHT containing MP [23]. Even if other clinical studies failed to demonstrate a significantly more favorable effect of MP compared to other progestogens, predominantly neutral effects on lipid metabolism have been observed [31]. Within the coagulation system, mainly the association of oral estrogens versus non-oral estrogens in relation to procoagulant markers has been well reported [32]. So far, in clinical studies, clear differences between pharmacologic classes of concomitant progestogens have not yet been described [33]. Only one clinical study demonstrated an increased activated protein C resistance in women using MHT containing norpregnane derivatives compared to those using MP [34], supporting the clinical observations in ESTHER and E3N
Severe multisystem inflammatory syndrome (MIS-C/A) after confirmed SARS-CoV-2 infection: a report of four adult cases
Published in Infectious Diseases, 2022
M. Sansone, M. Studahl, S. Berg, M. Gisslén, N. Sundell
A 43-year-old female with a history of activated protein C resistance was referred from primary health care to the department of infectious diseases with five days of high fever (∼40 C°), headache, sore throat, and tenderness at the left side neck. She had a PCR-confirmed mild SARS-CoV-2 infection six weeks prior. On admission, she had elevated CRP (140 mg/L) and mild leuko-and thrombocytopenia. The lymphocyte count was slightly low (1.0 × 109/L, reference range 1.1–3.5) and PCR was negative for SARS-CoV-2 in a swab from the nasopharynx. A suspected site of infection in the parapharyngeal area was detected on a CT scan. On day 2 she was transferred to the ICU due to hypotension and signs of cardiac dysfunction. Echocardiography was assessed as normal, but NT-pro-BNP was elevated. During hospitalisation, she developed bilateral non-purulent conjunctivitis and a skin rash. There was no evidence of Lemiérres syndrome or parapharyngeal abscess on further examinations. Symptoms gradually resolved without targeted MIS-C/A treatment, although she received a single dose of 100 mg of hydrocortisone i.v in the ICU for unknown reasons. No infectious pathogen was isolated, and no other plausible diagnosis was established despite extensive testing (including negative bacterial cultures from blood, urine and throat swabs, negative PCR for Fusobacterium necroforum, Arcanobacterium haemolyticum and a negative multiplex gastroenteritis PCR-panel). She improved spontaneously and was discharged after 14 days.