Medikamentöse Thromboseprophylaxe in der Schwangerschaft

Venöse Thromboembolien (VTE) sind eine der Hauptursachen für Morbidität und Mortalität in der Schwangerschaft und im Wochenbett. Zu den Hauptrisikofaktoren gehören vorausgegangene VTE, das Vorliegen einer Thrombophilie sowie eine positive Familienanamnese für VTE. Dieser Beitrag zeigt, in welchen Situationen eine VTE-Prophylaxe indiziert ist, welche Antikoagulanzien eingesetzt werden und wie das peri- und postpartale Management von antikoagulierten Schwangeren erfolgt.

Abstract

Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. The main VTE risk factors are previous VTE, known thrombophilia and a family history for VTE. This manuscript includes information on VTE risk assessment, anticoagulants that can safely be used in pregnancy, and the puerperium and the peripartal management of anticoagulated women.

Kernaussagen

• Eine Evaluation des individuellen VTE-Risikos sollte bei Frauen bereits vor bzw. zu Beginn einer Schwangerschaft, in Risikosituationen während einer Schwangerschaft sowie zum Geburtstermin und postpartal erfolgen.

• Zu den Hauptrisikofaktoren für eine VTE zählen vorausgegangene VTE, bekannte Thrombophilie sowie eine positive Familienanamnese.

• Eine postpartale VTE-Prophylaxe mit NMH ist bei allen Frauen mit vorausgegangener VTE indiziert. Eine antepartale Prophylaxe wird bei Z.n. hormonassoziierter VTE oder VTE spontaner Genese empfohlen sowie in Risikosituationen bei Z.n. VTE, die im Rahmen eines starken transienten, nicht hormonellen Risikofaktors (z.B. OP, Trauma) aufgetreten ist.

• Frauen mit milder Thrombophilie und unauffälliger VTE-Anamnese benötigen in der Regel keine antepartale VTE-Prophylaxe.

• Wie die HighLow-Studie kürzlich zeigte, ist eine intermediäre Dosierung von NMH der Prophylaxedosis in der Verhinderung eines VTE-Rezidivs nicht überlegen.

Schlüsselwörter

Thromboseprophylaxe - Schwangerschaft - Wochenbett

Keywords

venous thromboembolism prophylaxis - pregnancy - postpartum period

Publication History

Article published online:
02 June 2023

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