Lindhoff-Last Edelgard, Bauersachs Rupert
Department of Internal Medicine, Division of Angiology, University Hospital Frankfurt, Germany.
Semin Thromb Hemost. 2002 Oct;28(5):439-46. doi: 10.1055/s-2002-35284.
Heparin-induced thrombocytopenia (HIT) appears rarely in pregnant patients who are being treated with heparin. When HIT is suspected, heparin treatment should be discontinued and alternative anticoagulation should be started. The heparinoid danaparoid appears to be the drug of choice for acute treatment and prophylaxis because of its low placental permeability. Between the 12th and 36th weeks of pregnancy, either danaparoid may be continued or warfarin may be used after recovery of platelet counts. Before and during delivery, danaparoid should be preferred over warfarin in order to avoid bleeding complications in mother and infant. Hirudin should only be used when either cross-reactivity with heparin-induced antibodies or cutaneous allergy against heparinoids are observed. Postpartum warfarin seems to be the treatment of choice because breast-feeding can be continued. Alternative treatment with either danaparoid or hirudin is possible, but data on treatment with these reagents in lactating mothers are very limited.
肝素诱导的血小板减少症（HIT）在接受肝素治疗的孕妇中很少出现。当怀疑有HIT时，应停用肝素治疗并开始替代抗凝治疗。由于类肝素药物达那肝素的胎盘通透性低，它似乎是急性治疗和预防的首选药物。在妊娠第12周至36周之间，血小板计数恢复后，达那肝素可以继续使用，也可以使用华法林。在分娩前和分娩期间，为避免母婴出血并发症，应优先选择达那肝素而非华法林。只有在观察到与肝素诱导的抗体发生交叉反应或对类肝素药物有皮肤过敏反应时，才应使用水蛭素。产后华法林似乎是首选治疗方法，因为可以继续母乳喂养。也可以选择用达那肝素或水蛭素进行替代治疗，但关于这些药物在哺乳期母亲中的治疗数据非常有限。
