Zusammenfassung
Die Ergebnisse zahlreicher zumeist retrospektiver Studien der vergangenen 15 Jahre
weisen auf einen Zusammenhang zwischen der Entwicklung schwerwiegender Schwangerschaftskomplikationen
(SSK) und genetisch determinierten und erworbenen Thrombophilien hin. Die auf niedrigem
Evidenzniveau basierenden aktuellen Empfehlungen internationaler Expertengruppen (American
College of Chest Physicians, Pregnancy and Thrombosis Working Group, Royal College
of Obstetricians and Gynaecologists) zur Indikation einer Thrombophilieabklärung und
Antikoagulanziengabe bei Schwangeren mit SSK – außerhalb thrombotischer Ereignisse
– sind uneinheitlich, da für eine abschließende Beurteilung prospektive Studien mit
ausreichender statistischer Power unter Einbeziehung homogener Patientengruppen und
Anwendung multivariater Analysemodelle einschließlich standardisierter Komplikationsterminologien
fehlen. Obgleich ein gesichertes Interaktionsmodell für den Pathomechanismus einer
Thrombophilie und Ausbildung einer SSK gegenwärtig nicht verfügbar ist, stellen 75 %
aller befragten Pränatalabteilungen in England bei Frauen mit Spät- oder wiederholten
Aborten sowie Abruptio placentae die Indikation zu einer Thrombophilieabklärung und
machen den Einsatz einer Antikoagulanziengabe zur Prävention einer SSK in der Folgeschwangerschaft
davon abhängig. Es war das Ziel der vorliegenden Übersichtsarbeit, unter Berücksichtigung
aktueller prospektiver Untersuchungen die Studienlage zur Thrombophilie bei SSK und
Antikoagulanziengabe zur Prävention einer SSK kritisch zu beurteilen sowie Empfehlungen
zum praktischen Vorgehen zu erarbeiten.
Abstract
Results obtained in the last 15 years from a number of retrospective trials provide
evidence that there is an association between adverse pregnancy outcomes (APO) such
as early/late (recurrent) abortion, preeclampsia, intrauterine fetal growth retardation,
or abruptio placentae and the presence of inherited or acquired thrombophilic defects.
Although revised international recommendations (American College of Chest Physicians,
Pregnancy and Thrombosis Working Group, Royal College of Obstetricians and Gynaecologists)
for the investigation and management of thrombophilia in patients with APO apart from
thrombosis have been published recently, they are inconsistent and based on limited
evidence due to the lack of prospective trials performed in homogeneous groups of
patients using multivariate analysis and uniform terminologies for APO. However, according
to a recent British survey, 75 % of participating prenatal units perform routine thrombophilia
screening in women with APO, and the results guide the decision to administer anticoagulant
medication to prevent APO in subsequent pregnancies. A summary of current study results
of thrombophilia-associated APO and the prevention of APO (apart from thrombosis)
using anticoagulants was carried out, and more recent prospective trials are considered.
Recommendations for thrombophilia screening in APO as well as the use of anticoagulants
for the prevention of APO are discussed.
Schlüsselwörter
Thrombophilien - Pathophysiologie - schwangerschaftsassoziierte Komplikationen - Diagnostik
- Prävention mit niedermolekularen Heparinen
Key words
thrombophilia - pathophysiology - adverse pregnancy outcome - thrombophilia screening
- low molecular weight heparin
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Priv. Doz. Dr. med. Georg-Friedrich von Tempelhoff, FCATH
Abt. Gynäkologie und Geburtshilfe
Klinikum Aschaffenburg (Lehrkrankenhaus der Maximilians-Universität Würzburg)
Am Hasenkopf 1
63739 Aschaffenburg
Email: g-f.von.tempelhoff@gmx.de
