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

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

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