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Geburtshilfe Frauenheilkd 2001; 61(6): 355-363
DOI: 10.1055/s-2001-15426
Übersicht

Georg Thieme Verlag Stuttgart · New York

Die Anwendung von niedermolekularen Heparinen in der Schwangerschaft

The Use of Low Molecular Weight Heparin (LMWH) in PregnancyL. Heilmann1 , W. Rath2 , G. F. v. Tempelhoff1 , J. Harenberg3 , H. K. Breddin4 , W. Schramm5 , (im Namen der Gesellschaft für Thrombose- und Hämostaseforschung [GTH])
  • 1 Abteilung Gynäkologie und Geburtshilfe, Stadtkrankenhaus Rüsselsheim
  • 2 Universitätsfrauenklinik Aachen
  • 3 I. Medizinische Klinik des Universitätsklinikums Mannheim
  • 4 International Institute of Thrombosis and Vascular Diseases, Frankfurt/M.
  • 5 Klinikum Innenstadt, Abteilung Hämostaseologie, München
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Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung

Niedermolekulare Heparine ersetzen in zunehmendem Maße die unfraktionierten Heparine auch in der Schwangerschaft. Aufgrund der vorliegenden Daten ist eine angenäherte Komplikationsrate von 11,6 % bei 1884 Beobachtungen mit niedermolekularen Heparinen in der Schwangerschaft zu beobachten. Vaginale Blutungen traten bei ca. 3,4 %, venöse Thrombosen bei 1,7 %, Aborte bei 3 %, Frakturen bei 0,1 % und ein HIT II bei 0,05 % der Schwangeren auf. Die Einteilung in 3 Risikogruppen hat sich aus praktisch/klinischen Gesichtspunkten angeboten. Während Schwangere mit niedrigem Thromboserisiko allein einer postpartualen Prophylaxe bedürfen, sollten Frauen mit mittlerem Risiko in der gesamten Schwangerschaft mit einem niedermolekularen Heparin behandelt werden. Bei einer kleinen Gruppe von Schwangeren mit hohem Risiko ist dagegen eine therapeutische Dosis der niedermolekularen Heparine zu empfehlen. Das Antiphospholipidsyndrom ist mit einer hohen geburtshilflichen Komplikationsrate verbunden und erfordert eine enge Zusammenarbeit mit einem hämostaseologisch erfahrenen Labor.

Summary

Anticoagulant therapy for thromboprophylaxis in pregnancy usually consists of non-fractionated heparin (UFH) in a dose of 10,000 IU twice daily or of low molecular weight heparin (LMWH). The potential advantages of LMWH are based on the plasma half-life and on their 90 - 95 % bioavailability after s.c. administration. The complication rate of a pooled evaluation of patients treated during pregnancy with LMWH was 3.4 % for vaginal bleeding, 1.7 % for deep vein thrombosis, 3 % for spontaneous abortion, 0.1 % for osteoporotic fracture and 0.05 % for HIT II. Management of patients with hereditary hypercoagulable state in pregnancy is controversial because of the scarcity of data to guide decision making and because of inconsistencies among the available data . The working group of GTH “thrombophilia in pregnancy” recommended guidelines for the management of women who receive antithrombotic therapy for prophylaxis of venous thrombosis and pregnancy complications. Low-risk patients receiving post partum antithrombotic therapy, women with moderate risk LMWH from the first diagnosis of the pregnancy and patients with higher risk received “therapeutic doses” of LMWH. Patients with antiphospholipid antibody syndrome (APS) are associated with a high rate of adverse pregnancy complications and should be referred to a unit that specializes in the management of acquired thrombophilia in pregnancy.

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Prof. L. Heilmann

Abteilung Gynäkologie und Geburtshilfe
Stadtkrankenhaus

August-Bebel-Straße 59

65428 Rüsselsheim

Email: lotharheilmann@aol.com