Diagnostik und Therapie einer VTE in der Schwangerschaft

In Mitteleuropa zählen thromboembolische Komplikationen zu den häufigsten mütterlichen Todesursachen, die in Zusammenhang mit einer Schwangerschaft auftreten können. Eine tiefe Venenthrombose mit bzw. ohne Lungenembolie kompliziert etwa jede 1000. Schwangerschaft. Häufiger als bei Nichtschwangeren sind die Beckenvenen in das Thrombosegeschehen einbezogen. Im Folgenden werden das diagnostische Vorgehen bei Verdacht auf eine Thrombose bzw. Lungenembolie und wichtige therapeutische Aspekte dargestellt.

Abstract

In Central Europe thromboembolic complications are among the most common maternal causes of death associated with pregnancy. About 1 in 1000 pregnancies is accompanied by deep vein thrombosis with or without pulmonary embolism. During pregnancy the pelvic veins are more often involved in thrombotic events than in nonpregnant women. This article presents the diagnosis of suspected thrombosis or pulmonary embolism and important therapeutic aspects.

Kernaussagen

• Jeder klinische Verdacht auf eine tiefe Venenthrombose oder Lungenembolie in der Schwangerschaft erfordert so zeitnah wie möglich eine Abklärung, sodass eine sichere Therapieentscheidung getroffen werden kann.

• Die venöse Sonografie ist in den Händen eines erfahrenen Untersuchers sicher und die diagnostische Methode der Wahl zur Bestätigung oder zum Ausschluss einer tiefen Becken- bzw. Beinvenenthrombose in der Schwangerschaft.

• Bei Lungenembolieverdacht darf der Schwangeren eine CT-Pulmonalisangiografie oder Lungenperfusionsszintigrafie nicht aufgrund der Strahlenbelastung vorenthalten werden. Allerdings sollen vor Strahlenexposition die übrigen diagnostischen Verfahren ausgeschöpft werden.

• Heparine gehen nicht transplazentar auf das ungeborene Kind über und können sicher in der Schwangerschaft angewandt werden. Orale Antikoagulanzien (DOAK, VKA) sind plazentagängig und potenziell teratogen und sollen daher in der Schwangerschaft nicht zur Behandlung venöser Thromboembolien eingesetzt werden.

• In der Stillzeit gelten Heparine, Fondaparinux und Vitamin-K-Antagonisten als unbedenklich.

Schlüsselwörter

tiefe Venenthrombose - Lungenembolie - Schwangerschaft - Diagnose - Therapie

Keywords

deep vein thrombosis - pulmonary embolism - pregnancy - diagnosis - therapy

Publikationsverlauf

Artikel online veröffentlicht:
18. Oktober 2023

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