Winkler U H, Schindler A E
Universitäts-Frauenklinik Essen.
Geburtshilfe Frauenheilkd. 1996 Jun;56(6):301-12. doi: 10.1055/s-2007-1023235.
Pregnancy and especially delivery and the puerperium are associated with an increased risk of thromboembolic disease. Intravenous high dose heparin is the therapy of choice for manifest thromboembolic disease in pregnancy. However, high-dose heparin fails to prevent postthrombotic chronic venous insufficiency in more than one-third of the cases. Low-dose heparin may be used for antithrombotic prophylaxis during pregnancy. However, low-dose heparin may induce a substantial loss of bone density in up to 30% of cases and may be complicated by heparin-associated thrombopenia in up to 2%. This review discusses strategies to reduce these considerable risks. Prospective studies suggest that the risk of recurrence after prior deep vein thrombosis may be somewhat overestimated. These data suggest new therapeutic options in women with no risk factors other than a personal history of thrombosis. Improved diagnostic techniques may contribute to a better evaluation of the individual risk by assessing possible underlying problems such as resistance to activated protein C or deficiencies of coagulation inhibitors. Also, duration of prophylactic anticoagulation may be reduced by targeting treatment to periods of increased risk such as immobilisation, dehydration, surgery, delivery and the puerperium. Recently, evidence has been provided indicating that the use of low molecular weight heparins may be associated with reduced loss of bone density and a significantly attenuated risk of heparin-associated thrombopenia.
妊娠，尤其是分娩及产褥期，与血栓栓塞性疾病风险增加相关。静脉注射大剂量肝素是治疗妊娠期明显血栓栓塞性疾病的首选疗法。然而，在超过三分之一的病例中，大剂量肝素无法预防血栓形成后慢性静脉功能不全。低剂量肝素可用于妊娠期的抗血栓预防。然而，低剂量肝素在高达30%的病例中可能导致大量骨密度流失，且在高达2%的病例中可能并发肝素相关性血小板减少症。本综述讨论了降低这些重大风险的策略。前瞻性研究表明，既往有深静脉血栓形成后复发风险可能被略微高估。这些数据为除有血栓形成个人史外无其他危险因素的女性提供了新的治疗选择。改进的诊断技术通过评估可能的潜在问题，如对活化蛋白C的抵抗或凝血抑制剂缺乏，可能有助于更好地评估个体风险。此外，通过将治疗靶向于风险增加期，如制动、脱水、手术、分娩及产褥期，预防性抗凝的持续时间可能会缩短。最近，有证据表明，使用低分子量肝素可能与骨密度流失减少及肝素相关性血小板减少症风险显著降低相关。
