Kelbel C, Hafner G, Schinzel H, Prellwitz W, Weilemann L S
Abteilung für Innere Medizin mit Schwerpunkt Pneumologie, Universität Mainz.
Dtsch Med Wochenschr. 1994 Nov 4;119(44):1497-500. doi: 10.1055/s-2008-1058864.
A 26-year-old woman, on bedrest since the 6th week of pregnancy because of threatened abortion, developed thrombosis in the left iliac, superficial femoral and common femoral veins with small pulmonary emboli in the 11th week. Inhibitor deficiency was excluded. The thrombosis was only partially recanalized by unfractionated heparin at therapeutic dosage (38,400 IU per 24 h). As thrombolysis treatment and oral anticoagulation were contraindicated because of the threatened abortion, coagulation with low molecular weight heparin (LMWH) was started in the 18th week (5000 anti-Xa units daily subcutaneously). Maximal anti-Xa activity in plasma never exceeded 0.3 U/ml and there were no complications. The patient was delivered of a healthy girl (2,660 g, 48 cm) by caesarean section in the 37th week. Immediately post-partum LMWH was demonstrated with an anti-Xa activity of 0.3 U/ml in maternal blood, but none in simultaneously obtained cord venous blood. This case suggests that treatment of phlebothrombosis with LMWH is a reasonable measure even during pregnancy.
一名26岁女性，因先兆流产自妊娠第6周起卧床休息，在第11周时出现左髂静脉、股浅静脉和股总静脉血栓形成，并伴有小的肺栓塞。排除了抑制剂缺乏。使用治疗剂量的普通肝素（每24小时38,400国际单位），血栓仅部分再通。由于先兆流产，溶栓治疗和口服抗凝均为禁忌，因此在第18周开始使用低分子量肝素（LMWH）进行抗凝治疗（每日皮下注射5000抗Xa单位）。血浆中最大抗Xa活性从未超过0.3 U/ml，且无并发症。患者在第37周通过剖宫产分娩出一名健康女婴（体重2660克，身长48厘米）。产后即刻，母体血液中LMWH的抗Xa活性为0.3 U/ml，但同时采集的脐静脉血中未检测到。该病例表明，即使在妊娠期间，使用LMWH治疗静脉血栓形成也是一种合理的措施。
