Thrombophilie und Schwangerschaftskomplikationen

Zusammenfassung

Die Ergebnisse zahlreicher zumeist retrospektiver Studien der vergangenen 15 Jahre weisen auf einen Zusammenhang zwischen der Entwicklung schwerwiegender Schwangerschaftskomplikationen (SSK) und genetisch determinierten und erworbenen Thrombophilien hin. Die auf niedrigem Evidenzniveau basierenden aktuellen Empfehlungen internationaler Expertengruppen (American College of Chest Physicians, Pregnancy and Thrombosis Working Group, Royal College of Obstetricians and Gynaecologists) zur Indikation einer Thrombophilieabklärung und Antikoagulanziengabe bei Schwangeren mit SSK – außerhalb thrombotischer Ereignisse – sind uneinheitlich, da für eine abschließende Beurteilung prospektive Studien mit ausreichender statistischer Power unter Einbeziehung homogener Patientengruppen und Anwendung multivariater Analysemodelle einschließlich standardisierter Komplikationsterminologien fehlen. Obgleich ein gesichertes Interaktionsmodell für den Pathomechanismus einer Thrombophilie und Ausbildung einer SSK gegenwärtig nicht verfügbar ist, stellen 75 % aller befragten Pränatalabteilungen in England bei Frauen mit Spät- oder wiederholten Aborten sowie Abruptio placentae die Indikation zu einer Thrombophilieabklärung und machen den Einsatz einer Antikoagulanziengabe zur Prävention einer SSK in der Folgeschwangerschaft davon abhängig. Es war das Ziel der vorliegenden Übersichtsarbeit, unter Berücksichtigung aktueller prospektiver Untersuchungen die Studienlage zur Thrombophilie bei SSK und Antikoagulanziengabe zur Prävention einer SSK kritisch zu beurteilen sowie Empfehlungen zum praktischen Vorgehen zu erarbeiten.

Abstract

Results obtained in the last 15 years from a number of retrospective trials provide evidence that there is an association between adverse pregnancy outcomes (APO) such as early/late (recurrent) abortion, preeclampsia, intrauterine fetal growth retardation, or abruptio placentae and the presence of inherited or acquired thrombophilic defects. Although revised international recommendations (American College of Chest Physicians, Pregnancy and Thrombosis Working Group, Royal College of Obstetricians and Gynaecologists) for the investigation and management of thrombophilia in patients with APO apart from thrombosis have been published recently, they are inconsistent and based on limited evidence due to the lack of prospective trials performed in homogeneous groups of patients using multivariate analysis and uniform terminologies for APO. However, according to a recent British survey, 75 % of participating prenatal units perform routine thrombophilia screening in women with APO, and the results guide the decision to administer anticoagulant medication to prevent APO in subsequent pregnancies. A summary of current study results of thrombophilia-associated APO and the prevention of APO (apart from thrombosis) using anticoagulants was carried out, and more recent prospective trials are considered. Recommendations for thrombophilia screening in APO as well as the use of anticoagulants for the prevention of APO are discussed.

Schlüsselwörter

Thrombophilien - Pathophysiologie - schwangerschaftsassoziierte Komplikationen - Diagnostik - Prävention mit niedermolekularen Heparinen

Key words

thrombophilia - pathophysiology - adverse pregnancy outcome - thrombophilia screening - low molecular weight heparin

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