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Hamostaseologie 2001; 21(03): 130-142
DOI: 10.1055/s-0037-1619510
Original article
Schattauer GmbH

Die Anwendung der niedermolekularen Heparine in der Frauenheilkunde

Low-molecular-weight heparin in gynecology
L. Heilmann
1   Abt. Gynäkologie und Geburtshilfe, Stadtkrankenhaus Rüsselsheim (Chefarzt: Prof. Dr. Lothar Heilmann)
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Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Niedermolekulare Heparine werden in der Frauenheilkunde nicht nur zur postoperativen Thromboseprophylaxe, sondern auch in der Onkologie sehr breit eingesetzt. Dabei liegt der Schwerpunkt auf dem Gebiet der Verhütung thromboembolischer Komplikationen während der Chemotherapie, aber auch direkte Wirkungen auf Tumorwachstum und Überlebenszeit der Patientinnen werden diskutiert. In der Schwangerschaft haben sich die niedermolekularen Heparine ebenfalls etabliert. Dabei steht die Verhütung von Schwangerschaftskomplikationen, wie Präeklampsie, intrauterine Wachstumsretadierung, intrauteriner Fruchttod und habitueller Abort, im Vordergrund. Thromboembolische Komplikationen haben aufgrund ihrer geringeren Inzidenz eine nachgeordnete Bedeutung.

Summary

The results of numerous clinical trials are supporting the superior efficacy and relative safety of low-molecular-weight heparin (LMWH) compared with unfractionated heparin (UFH) in gynecology/obstetrics. Several clinical trials compared LMWH with UFH for prevention of deep vein thrombosis and their results favored LMWH in reducing overall mortality in cancer patients, recurrent thromboembolic events and major bleeding complications. In addition, data indicate that LMWH given with low dose aspirin is more effective than aspirin alone in treating patients with recurrent spontaneous abortion. Because the optimal dosage of LMWH has not been established for pregnant patients, monitoring may be warranted in these cases. Women are at an estimated 5-fold increased risk for developing deep vein thrombosis during pregnancy and the puerperium compared with nonpregnant women of similar age. The LMWHs for anticoagulation are attractive because of the potential for once or twice daily dosing, decreased frequency of laboratory monitoring and dosage adjustment, safety during delivery and lower risk for heparin induced osteoporosis.

Schlüsselwörter

Schwangerschaft - postoperative Thrombose - Hormonersatztherapie (HRT) - Thrombophilie - niedermolekulare Heparine

Keywords

Pregnancy - postoperative thrombosis - hormone replacement therapy (HRT) - thrombophilia - low-molecular-weight heparin
 

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