Schneider D, Heilmann L, Harenberg J
Abteilung für Gynäkologie und Geburtshilfe, Stadtkrankenhaus Rüsselsheim.
Geburtshilfe Frauenheilkd. 1995 Feb;55(2):93-8. doi: 10.1055/s-2007-1022782.
Prophylaxis of thromboembolism in pregnancy with low molecular weight heparin (LMWH) offers several advantages over conventional heparin (UFH) including the once daily application and the reduction of heparin-related side effects like osteoporosis, thrombocytopenia and allergy. Until now the use of LMWH in obstetrics failed because of a possible placental passage. The aim of our randomised controlled study with a total of 59 pregnant women was to control the placental passage of UFH and LMWH at term. 35 pregnant women received either 5000 I.U. UFH or 1500 aPTT units LMWH (Mono-Embolex) subcutaneously two hours prior to the termination or no injection. Maternal and fetal blood samples were taken after delivery to assay heparin activity by the heptest coagulation assay and the S2222 chromogenic substrate method. After application of LMWH heptest coagulation assay rose significantly from 20.8 +/- 2.0 to 40.3 +/- 9.4 s (p = 0.001), after UFH just from 21.6 +/- 1.5 to 22.9 +/- 3.7 s (p = 0.09). In the fetal blood samples, however, neither UFH nor LMWH could be measured. The data demonstrates that neither UFH nor LMWH used in this study crosses the placenta two hours after application and encourages the use of LMWH for the prophylaxis of thromboembolism during pregnancy.
与传统肝素（UFH）相比，使用低分子量肝素（LMWH）预防妊娠血栓栓塞具有诸多优势，包括每日一次给药以及减少肝素相关副作用，如骨质疏松、血小板减少和过敏。到目前为止，LMWH在产科的应用因可能通过胎盘而失败。我们对总共59名孕妇进行的随机对照研究的目的是在足月时控制UFH和LMWH的胎盘通过情况。35名孕妇在分娩前两小时皮下注射5000国际单位UFH或1500 aPTT单位LMWH（Mono - Embolex），或不注射。分娩后采集母血和胎儿血样本，通过七因子检测凝血试验和S2222发色底物法测定肝素活性。应用LMWH后，七因子检测凝血试验从20.8±2.0秒显著升至40.3±9.4秒（p = 0.001），应用UFH后仅从21.6±1.5秒升至22.9±3.7秒（p = 0.09）。然而，在胎儿血样本中，UFH和LMWH均未检测到。数据表明，本研究中使用的UFH和LMWH在应用两小时后均未穿过胎盘，这鼓励在孕期使用LMWH预防血栓栓塞。
