Thrombophile Hämostasestörung in der Schwangerschaft

Zusammenfassung

Frauen, die Trägerinnen angeborener und/oder erworbener thrombophiler Risikofaktoren sind, haben ein erhöhtes Risiko für schwangerschaftsassoziierte vaskuläre Komplikationen wie venöse Thromboembolien, Abort, Präeklampsie und intrauterine Wachstumsretardierung. Diese Komplikationen gehen mit hoher maternaler und fetaler Morbidität und Mortalität einher. Eine antikoagulatorische Therapie in der Schwangerschaft ist zur risikoadaptierten Prävention und Behandlung venöser thromboembolischer Komplikationen sowie zur Prävention von Aborten bei Frauen mit Antiphospholipidsyndrom indiziert. Angesichts der Studien, die eine Assoziation zwischen hereditärer Thrombophilie und schwangerschaftsassoziierten Komplikationen zeigen, erfolgt zunehmend auch der Einsatz von Heparin zur Prävention schwangerschaftsbedingter vaskulärer Komplikationen. Die Therapieempfehlungen bei Frauen mit thrombophilen Risikofaktoren und Abortneigung, Präeklampsie und intrauteriner Wachstumsretardierung werden kontrovers diskutiert, da keine großen randomisierten Placebo-kontrollierten Therapiestudien verfügbar sind. Trotz dieser Limitationen und fehlendem internationalen Konsens haben positive Studienergebnisse die klinische Praxis und auch die Erwartungshaltung der Patientinnen zugunsten einer Heparinprophylaxe beeinflusst. Für die abschließende Wertung sind randomisierte Placebo-kontrollierte Studien nötig.

Summary

Women with acquired and hereditary thrombophilia are at increased risk of developing venous thromboembolism and other associated gestational vascular complications like fetal loss, preeclampsia, intrauterine growth restriction, and placental abruption during pregnancy. These complications are a major cause of maternal and fetal morbidity and mortality. In view of the data showing an association between thrombophilia and these adverse pregnancy outcomes, clinicians are increasingly using antithrombotic therapy in women at risk of these complications. Aside from recurrent pregnancy loss in antiphospholipid syndrome and prevention of venous thromboembolism, there is limited evidence on the benefit of antithrombotic interventions to guide therapy. The data in favour of antithrombotic therapy in women with hereditable thrombophilia and vascular placental complications consist predominantly of small uncontrolled trials or observational studies. Randomized, placebo- controlled trials are lacking as most patients do not accept placebo. Further randomised controlled trials are urgently required to explore this therapeutic option.

Schlüsselwörter

Thrombophilie - Thrombose - Abort - Präeklampsie - intrauterine Wachstumsretardierung

Keywords

Thrombophilia - venous thromboembolism - fetal loss - preeclampsia - intrauterine growth restriction

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