Prophylaxis and Therapy of Venous Thrombotic Events (VTE) in Pregnancy and the Postpartum Period

Christoph Sucker

doi:10.1055/a-1030-4546

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(01): 48-59
DOI: 10.1055/a-1030-4546

GebFra Science

Review/Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Prophylaxe und Therapie venöser thrombotischer Ereignisse (VTE) in Schwangerschaft und Wochenbett

Article in several languages: English | deutsch

Authors

Christoph Sucker

Gerinnungszentrum Berlin Dr. Sucker, Berlin, Germany

Abstract

Zusammenfassung

Venöse Thromboembolien und Lungenembolien sind eine der Hauptursachen von Morbidität und Mortalität in der Schwangerschaft. Das durch die physiologischen Veränderungen während der Schwangerschaft bedingte erhöhte Risiko thrombotischer Ereignisse rechtfertigt alleine noch keine medikamentöse antithrombotische Prophylaxe. Kommen allerdings weitere Risikofaktoren wie Thrombosen in der Vorgeschichte, hormonelle Stimulation im Rahmen einer Kinderwunschbehandlung, Thrombophilie, höheres Schwangerenalter, gravierendes Übergewicht oder prädisponierende Begleiterkrankungen hinzu, muss das Thromboserisiko – nach Möglichkeit von einem Gerinnungsspezialisten – neu bewertet und gegebenenfalls eine medikamentöse Prophylaxe eingeleitet werden. Niedermolekulare Heparine (NMH) sind die Standardmedikation zur Prophylaxe und Therapie thrombotischer Ereignisse in Schwangerschaft und Wochenbett. Eine in der Schwangerschaft begonnene medikamentöse Thromboseprophylaxe wird aufgrund des im Wochenbett gipfelnden Thromboserisikos in der Regel für ca. 6 Wochen nach der Entbindung fortgeführt. Gleiches gilt für die therapeutische Antikoagulation nach Auftreten eines thrombotischen Ereignisses in der Schwangerschaft; hier sollte auch eine Mindestdauer der Therapie von 3 Monaten eingehalten werden. In der Stillzeit kommen NMH oder das orale Antikoagulans Warfarin in Betracht; beide Wirkstoffe gehen nicht in die Muttermilch über.

Schlüsselwörter

Thromboembolien - Schwangerschaft - Antikoagulation - niedermolekulare Heparine - orale Antikoagulanzien

Full Text

References

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