Geburtshilfe. Thrombose und Schwangerschaft

Eine venöse Thrombose (TBVT) in der Schwangerschaft geht mit erheblichen Risiken für Mutter und Kind einher. Jeder Verdacht bedarf deshalb einer sofortigen und eindeutigen Abklärung unter Berücksichtigung der Risiken für das ungeborene Kind durch die Diagnostik. Die Klinik ist häufig unspezifisch, und erprobte Diagnosealgorithmen fehlen für schwangere Patientinnen. Mehr zu Diagnostik und Therapie erfahren Sie im Folgenden.

• Literatur

• 1 Marik PE, Plante LA. Current concepts: venous thromboembolic disease and pregnancy. N Engl J Med 2008; 19: 2025-2033
• 2 Heit JA, Kobbervig CE, James AH et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 10: 697-706
• 3 James AH, Jamison MG, Brancazio LR et al. Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 5: 1311-1315
• 4 Randrianarisoa E, Abele H, Balletshofer B. Diagnosis and treatment of venous thromboembolism during pregnancy and puerperium. Phlebologie 2013; 6: 315-321
• 5 Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999; 9160: 1258-1265
• 6 Greer IA. The challenge of thrombophilia in maternal-fetal medicine. N Engl J Med 2000; 6: 424-425
• 7 Ginsberg JS, Brilledwards P, Burrows RF et al. Venous thrombosis during pregnancy – leg and trimester of presentation. Thromb Haemost 1992; 5: 519-520
• 8 Wells PS, Ginsberg JS, Anderson DR et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998; 12: 997
• 9 Wells PS, Anderson DR, Rodger M et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 13: 1227-1235
• 10 OʼConnor C, Moriarty J, Walsh J et al. The application of a clinical risk stratification score may reduce unnecessary investigations for pulmonary embolism in pregnancy. J Matern Fetal Neonatal Med 2011; 12: 1461-1464
• 11 Kline JA, Williams GW, Hernandez-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005; 5: 825-829
• 12 Stein PD, Hull RD, Patel KC et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism – a systematic review. Ann Intern Med 2006; 8: 589-602
• 13 Sivandarajah S, Horner D. Current evidence does not support the use of a negative D-dimer to rule out suspected pulmonary embolism in pregnancy. Emerg Med J 2011; 3: 245-246
• 14 Chan WS, Lee A, Spencer FA et al. D-dimer testing in pregnant patients: towards determining the next ‘level’ in the diagnosis of deep vein thrombosis. J Thromb Haemost 2010; 5: 1004-1011
• 15 Gonser L, Strolin A. Thromboembolic complications and the importance of thrombophilia in pregnancy. Phlebologie 2013; 6: 309-314
• 16 Elias A, Lecorff G, Bouvier JL et al. Value of real-time B-mode ultrasound imaging in the diagnosis of deep-vein thrombosis of the lower-limbs. Int Angiol 1987; 2: 175-182
• 17 Junqueira DRG, Carvalho MD, Perini E. Heparin-induced thrombocytopenia: a review of concepts regarding a dangerous adverse drug reaction. Rev Assoc Med Bras 2013; 2: 161-166
• 18 Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005; 2: 401-407
• 19 Schaefer C, Hannemann D, Meister R et al. Vitamin K antagonists and pregnancy outcome – a multi-centre prospective study. Thromb Haemost 2006; 6: 949-957
• 20 Bates SM, Greer IA, Middeldorp S et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy antithrombotic therapy and prevention of thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 2: E691S-E736S
• 21 Bauersachs R, Berkowitz SD, Brenner B et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010; 26: 2499-2510
• 22 Büller HR, Prins MH, Lensing AW et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012; 14: 1287-1297
• 23 Gogarten W, van Aken H, Büttner J et al. AWMF Leitlinien Nr. 001/005: Rückenmarknahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anästh Intensivmedizin 2007; 48: 109-124
• 24 Horlocker TT, Wedel DJ, Rowlingson JC et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy. American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 1: 64-101
• 25 Hach-Wunderle V et al. AWMF Leitlinie Nr. 065/002: Diagnostik und Therapie der Venenthrombose und der Lungenembolie (AWMF online 2010).. Online: http://www.awmf.org/leitlinien/detail/ll/065-002.html Stand: 06/2010
• 26 Harenberg J, Heilmann L, Rath W et al. Niedermolekulare Heparine in der Schwangerschaft. Dtsch Ärztebl 2002; 99: A424-A432
• 27 Hajduk B, Tomkowski WZ, Matek G et al. Vena cava filter occlusion and venous thromboembolism risk in persistently anticoagulated patients. A prospective, observational cohort study. Chest 2009; 4: 877-882
• 28 Lyon SM, Riojas GE, Uberoi R et al. A short- and long-term retrievability of the celect vena cava filter: results from a multi-institutional registry. J Vasc Interv Radiol 2009; 11: 1441-1448
• 29 Leonhardt G, Gaul C, Nietsch HH et al. Thrombolytic therapy in pregnancy. J Thromb Thrombolysis 2006; 3: 271-276
• 30 Buchtemann AS, Steins A, Volkert B et al. The effect of compression therapy on venous haemodynamics in pregnant women. Br J Obstet Gynaecol 1999; 6: 563-569