Gerinnungsstörungen der Frau

Gerinnungsstörungen sind im klinischen Alltag unabhängig von der Fachrichtung ein immer wiederkehrender Begleiter. Bei Frauen müssen durch Schwangerschaften oder exogene Hormonzufuhr zusätzliche Einflussfaktoren berücksichtigt werden. Dieser Artikel gibt einen Überblick über die wichtigsten Thrombo-/Hämophilien und den Umgang mit ihnen in der medizinischen Praxis.

Kernaussagen

• Ein Thrombophiliescreening kann als Einzelfallentscheidung bei idiopathischen, rezidivierenden Thrombosen, atypischen Thromboselokalisationen, Erstereignis im jungen Alter oder starker positiver Familienanamnese erwogen werden.

• Das Thromboserisiko steigt in der folgenden Reihenfolge an: Frauen ohne hormonelle Verhütung = Levonorgestrel-freisetzende Spirale = orale Gestagen-Monopräparate < Gestagen-Implantate < 2. Generation KOK < 3. Generation KOK = Drospirenon-haltige KOK = CPA- und CMA-haltige KOK = vaginaler Verhütungsring = Verhütungspflaster.

• Beim absoluten Thromboserisiko in der Schwangerschaft und postpartal von ≥ 3% sollte eine medikamentöse Thromboseprophylaxe empfohlen werden.

• Eine Empfehlung zur Prophylaxe von Schwangerschaftskomplikationen mit NMH kann aktuell bei Frauen weder mit noch ohne Thrombophilie gegeben werden.

• Bei der Verordnung der NMH-Therapie in der Schwangerschaft sollten der Nutzen, die Nachteile und die persönlichen Präferenzen der Patientin berücksichtigt werden.

• Eine Verlängerung der postoperativen Thromboseprophylaxe bis 4 Wochen nach onkologischen Eingriffen wird empfohlen.

• Bei onkologischen Patientinnen sollte eine laufende therapeutische Antikoagulation unabhängig von der Indikation mindestens für die Dauer der spezifischen onkologischen Therapie bzw. des Fortbestehens der aktiven onkologischen Erkrankung fortgeführt werden.

• Kombinierte hormonelle Kontrazeptiva und eine Levonorgestrel-haltige Spirale sind die Therapie der Wahl für Blutungsstörungen aufgrund einer Hämophilie.

• Bei bekannter Hämophilie sind die Gerinnungskontrollen bei Feststellung der Schwangerschaft, in der 28. und 34. SSW sowie eine Betreuung sinnvoll.

Schlüsselwörter

Thrombophilie - Blutungsneigung - Thrombose - Schwangerschaft - Onkologie

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