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CC BY-NC-ND 4.0 · Thromb Haemost
DOI: 10.1055/a-2791-6450
Original Article: Cellular Haemostasis and Platelets

Decreasing Platelet Aggregation Despite Increasing Soluble P-selectin during Pregnancy in Women with and without Heterozygous Factor V Leiden Mutation

Authors

  • Margunn Bye Tøsdal 

    1   Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
    2   Department of Clinical Science, University of Bergen, Bergen, Norway

  • Turid Helen Felli Lunde

    3   Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
    4   Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway

  • Tor Hervig

    2   Department of Clinical Science, University of Bergen, Bergen, Norway

  • Chen Sun

    5   Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway

  • Sverre Sandberg

    6   Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway

  • Marit Hellum

    7   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
    8   Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway

  • Carola Elisabeth Henriksson

    7   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
    8   Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway

  • Ann Helen Kristoffersen

    1   Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
    6   Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway

Funding Information This work was funded by the Department of Laboratory Medicine/Department of Medical Biochemistry and Pharmacology MBF, Haukeland University Hospital, Helse Bergen except for sP-selectin, which was funded by the University of Oslo, Oslo. Ann Helen Kristoffersen received postdoctoral fellowship from the Western Norway Regional Health Authority.
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Graphical Abstract

Abstract

Background

Risk of venous thromboembolism (VTE) is increased in pregnancy and postpartum, and 40% of VTEs in pregnancy (Caucasians) are associated with heterozygous factor V Leiden mutation (FVL). Thrombin generation is increased in individuals with FVL and in pregnant women, and thrombin amplifies both platelet and coagulation activation. Although both contribute to VTE pathophysiology, the mechanisms of platelet activation in pregnant women, particularly with heterozygous FVL, remain poorly understood.

Objectives

To describe the physiological course of the platelet activation marker plasma soluble P-selectin (sP-selectin), whole blood platelet aggregation, and thromboelastography (TEG) parameters throughout pregnancy and postpartum, and assess differences between women with and without heterozygous FVL.

Patients/Methods

A total of 22 pregnant women with heterozygous FVL and 22 without were enrolled. Blood samples were collected at multiple time points during and after pregnancy. Platelet activation and aggregation were evaluated using sP-selectin, multiple electrode aggregometry (MEA) with adenosine diphosphate, arachidonic acid, thrombin receptor-activating peptide-6 as agonists, and TEG.

Results

sP-selectin levels increased significantly during pregnancy, while platelet aggregation decreased in response to all agonists (P < 0.005). TEG maximum amplitude (MA) increased throughout pregnancy. No significant differences were observed between women with and without FVL.

Conclusion

In late pregnancy, decreased platelet aggregation responses were observed alongside increased sP-selectin levels, with no differences in levels between women with and without heterozygous FVL. These findings indicate that the presence of heterozygous FVL does not significantly influence platelet function during pregnancy. The cause of the unexpected, reduced platelet aggregation remains unclear and warrants further investigation.

Keywords

platelet aggregation - pregnancy - P-selectin - thrombophilia - venous thromboembolism

Supplementary Material



Publication History

Received: 22 April 2025

Accepted: 18 January 2026

Article published online:
02 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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