Medikamentöse Thromboseprophylaxe in Schwangerschaft und Wochenbett: aktuelle Empfehlungen

Venöse Thromboembolien sind eine der häufigsten mütterlichen Todesursachen weltweit. Schwangere, die an einer Lungenembolie versterben, weisen in 80 % der Fälle identifizierbare Risikofaktoren auf. Die frühzeitige Erfassung dieser Risikofaktoren vor und nach der Geburt kann zusammen mit einer adäquaten Thromboseprophylaxe die Häufigkeit um ca. 60–70 % senken.

• Literatur

• 1 Goecke TW, Rath W. Tiefe Bein-/Beckenvenenthrombose und Lungenembolie. In: Rath W, Gembruch U, Schmidt S. Geburtshilfe und Pränatalmedizin. Georg Thieme; 2.. Aufl. 2010: 352-371
• 2 Jacobsen AE, Skjeldestrad FE, Sandset PM. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost 2008; 6: 905-912
• 3 James AH. Prevention and management of venous thromboembolism in pregnancy. Am J Med 2007; 120: 526-534
• 4 James AH. Pregnancy and the thrombotic risk. Crit Care Med 2010; 38: 557-563
• 5 Kher A, Bauersachs R, Niesen JD. The management of thrombosis in pregnancy: role of low-molecular weight heparin. Thromb Haematol 2007; 97: 505-513
• 6 Bates JM, Greer JA, Pabinger J et al. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy. American College of Chest Physicians Evidence-based clinical practice guidelines (8th edition) Chest 2008; 133: S844-S886
• 7 AWMF-S3-Leitlinie 003/001 Prophylaxe der venösen Thromboembolie (VTE). 2008 http://leitlinien-net/1–152
• 8 Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 37 Reducing the risk of thrombosis and embolism during pregnancy and the puerperium. 01/2010
• 9 Brill-Edwards P, Ginsberg JS for the Recurrence of Clot In This Pregnancy (ROCIT) Study Group Safety of withholding antepartum heparin in women with a previous episode of venous thromboembolism. N Engl J Med 2000; 343: 1439-1444
• 10 De Stefano V, Martinelli I, Rossi E et al. The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis. Br J Haematol 2006; 135: 386-391
• 11 White RH, Chen WS, Zhou H, Ginsberg JS. Recurrent venous thromboembolism after pregnancy-associated versus unprovoked thromboembolism. Thromb Haemost 2008; 100: 246-252
• 12 Marik PE, Plante LA. Venous thromboembotic disease and pregnancy. N Engl J Med 2008; 359: 2025-2033
• 13 Rath W, von Tempelhoff G-F. Thrombophiliediagnostik – praktische Bedeutung Teil 2. Frauenarzt 2011; 52: 460-467
• 14 von Tempelhoff G-F, Koscielny J, Rath W. Thrombophilie und Schwangerschaftskomplikationen. Geburtsh. Frauenheilk 2011; 71: 105-118
• 15 Blanco-Molina A, Trujillo-Santos J, Criado J et al. RIETE Investigators venous thromboembolism during pregnancy or puerperium: findings from the RIETE Registry. Thromb Haemost 2007; 97: 186-190
• 16 Rath W. Thromboseprophylaxe in Schwangerschaft und im Wochenbett: Highlights aus aktuellen Leitlinien. Z Geburtsh Neonatol 2010; 214: 217-228
• 17 Jacobsen AF, Skjedelstad FE, Sandset PM. Incidence and risk pattern of venous thromboembolism in pregnancy and puerperium – a register-based case-control study. Am J Obstet Gynecol 2008; 198: 233e1-233e7
• 18 Confidential Enquiries into Maternal and Child Health. Saving ‘Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer, 2003 – 2005.. The Seventh Report of the Confidential Enquiring into Maternal Deaths in the United Kingdom London: CEMACH; 2007
• 19 Heit JA, Kobbervig CE, James AH et al. Trends in the incidence of venous thromboembolism during pregnancy and postpartum: a 30-year population-based study. Ann Intern Med 2005; 143: 697-706
• 20 Lin S, Liston RM, Joseph KS et al. Maternal mortality and severe morbidity associated with low-risk planned caesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176: 455-460
• 21 Blondon M. Thromboprophylaxis after cesarean section: decision analysis. Thromb Res 2011; 127 (Suppl. 3) S9-S12
• 22 Heilmann L, Rath W, von Tempelhoff GF et al. Niedermolekulare Heparine in der Schwangerschaft. Deutsch Ärzteblatt 2002; 99: 424-432
• 23 Gogarten W, van Aken H, Büttner J et al. Rückenmarksnahe Regionalanästhesie und Thromboembolieprophylaxe/anti-thrombotische Medikation. 2. überarbeitete Empfehlung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin Anästh Intensivmed 2007; 48: 5109-5124
• 24 Greer JA, Nelson-Piercy C. Low-molecular-weight heparin for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005; 106: 401-407
• 25 Marik PE. Venous thromboembolism in pregnancy. Clin Chest Med 2010; 31: 731-740
• 26 Schaefer C, Spielmann H, Vetter K, Weber-Schöndorfer C. Arzneimittel in Schwangerschaft und Stillzeit. Urban & Fischer; 8. Aufl. 2012
• 27 Bauersachs RM, Dudenhausen JW, Faridi A et al. Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women. Thromb Haemost 2007; 98: 1237-1245