Briel R C
Universitäts-Frauenklinik Tübingen.
Z Geburtshilfe Perinatol. 1987 Sep-Oct;191(5):186-92.
This paper presents a review of the current status of prevention and treatment of thromboses in pregnancy and reports the author's own results. Thromboembolism prophylaxis during pregnancy is accomplished with low-dose heparin, and is recommended for patients with a history of thrombosis and/or embolism. Heparin does not permeate the placenta; therefore, long-term use of it in low doses does not involve a risk. Complication-free courses in 18 pregnancies during which low-dose heparin was administered by the author are described. In cases of manifest deep thrombosis in the iliofemoral vein during pregnancy it is advisable today to perform thrombectomy as an alternative to fibrinolysis. This is followed by continuous administration of heparin in a therapeutic doses. Primary heparin treatment is given for thromboses of the knee and lower leg. The individual therapeutic methods are compared on the basis of information in the literature and the author's personal experience with 34 cases. Coumarins should no longer be used during pregnancy. In view of the risk of osteoporosis under high-dose long-term heparinization, one should switch to coumarins as soon as possible post partum; the coumarins are only detectable in traces in the mother's milk. Deep thromboses during pregnancy can only be treated with some promise of success if there is optimal cooperation between gynecologist, hemostasiologist and, if necessary, a vascular surgeon.
本文综述了妊娠期血栓形成的防治现状，并报告了作者自己的研究结果。妊娠期血栓栓塞的预防采用低剂量肝素，推荐用于有血栓形成和/或栓塞病史的患者。肝素不会透过胎盘；因此，长期小剂量使用肝素没有风险。本文描述了作者进行的18例妊娠期小剂量肝素治疗且无并发症的病例。对于妊娠期出现的明显的髂股静脉深静脉血栓形成，如今建议采用血栓切除术替代纤维蛋白溶解疗法。随后持续给予治疗剂量的肝素。对于膝部和小腿的血栓形成，采用肝素进行初始治疗。根据文献资料和作者对34例病例的个人经验，对不同的治疗方法进行了比较。妊娠期不应再使用香豆素类药物。鉴于长期大剂量使用肝素会有骨质疏松的风险，产后应尽快改用香豆素类药物；香豆素类药物在母乳中仅能检测到微量。只有在妇科医生、止血专家以及必要时血管外科医生之间进行最佳协作的情况下，妊娠期深静脉血栓形成才有可能得到成功治疗。
