(578) Coagulation Markers Among Preeclamptic Pregnancies: A Systematic Review and Meta-Analysis

Objective:
To assess the alterations in coagulation markers among women with preeclampsia compared to normotensive pregnant women, in order to assess their potential utility in the clinical assessment and management of preeclampsia.

Study Design:

A comprehensive literature search was conducted across PubMed, Embase and Cochrane Library to identify studies published up to July 2025. Studies were included comparing coagulation parameters, such as antithrombin III, fibrinogen, and D-dimer, between preeclamptic and normotensive pregnant women. Pooled mean differences and 95% confidence intervals were calculated using a random-effects model and heterogeneity through I² statistics on RevMan.

Results:
The primary finding was that Antithrombin III levels were significantly higher in normotensive pregnant women (MD = -10.35; 95% CI: -14.89 to -5.80; p < 0.00001; Figure A), reinforcing the notion that preeclampsia is associated with reduced anticoagulant capacity andendothelial dysfunction. We also assessed D-dimer levels, which were significantly higher in preeclamptic pregnant women (MD= 393.21; 95% CI: 247.44 to 538.99; p < 0.00001; Figure B), suggesting a relevant marker of coagulation activation, though not specific to the condition, given their elevation in normotensive women as well. As for fibrinogen, no significant difference was observed between groups (MD = -0.13; 95% CI: -0.54 to 0.27; p = 0.52; Figure C), suggesting it may not be a reliable marker to distinguish preeclamptic and normotensive pregnancies.

Conclusion:
Our findings reveal a distinct prothrombotic profile in preeclamptic pregnancies, marked by elevated D-dimer and reduced antithrombin III levels compared to normotensive women, features reflecting endothelial dysfunction and increased coagulation activity. These markers enhance our understanding of preeclampsia’s hemostatic changes and may serve as accessible, non-invasive tools for early detection, monitoring, and risk stratification. As research progresses, incorporating coagulation biomarkers into predictive models and therapeutic strategies may enable more precise management of the condition.