Thrombophilia and pregnancy complications

Zusammenfassung

Venöse Thrombosen und Lungenembolien sind die führende Ursache schwangerschaftsbedingter Morbidität und Mortalität. Frauen mit Thrombophilie haben ein erhöhtes Thromboserisiko während der Schwangerschaft und des Puerperiums. Bei Frauen mit hereditärem Thromboserisikofaktor wurde ein relatives Risiko von 3,4 bis 15,2 für eine schwangerschaftsassoziierte Thrombose festgestellt. Frauen mit vorangegangener Thrombose haben während der Schwangerschaft ein 3,5-mal höheres Rezidivrisiko als sonst.

Die Daten über eine Assoziation zwischen Thrombophilie und Aborten oder Präeklampsie sind widersprüchlich. Abgesehen von einer etablierten Risikoerhöhung für Aborte durch Antiphospholipid-Antikörper gibt es Hinweise für eine Bedeutung des Antithrombinmangels, der Hyperhomozysteinämie, des Faktor V Leiden, der Prothrombin- G20210A-Variation und des Protein-S-Mangels. Ein Zusammenhang zwischen Thrombophilie und Präeklampsie ist weniger gut belegt. Die Zahl verfügbarer, prospektiver Studien ist begrenzt, und diese fanden keine Risikoerhöhung in einem unselektionierten Patientengut mit Thromboserisikofaktor. Verfügbar sind Daten einer kontrollierten Studie über die Prävention eines Schwangerschaftsverlusts mittels niedermolekularem Heparin (NMH), welches eine starke positive Wirkung zeigte. Thrombophilie-Screening mag bei Frauen mit Aborten, insbesondere ab der 10 Schwangerschaftswoche, angezeigt sein und eine Prophylaxe mit NMH sollte bei jenen Frauen überlegt werden, bei denen eine Thrombophilie festgestellt wird. Weitere prospektive Studien und kontrollierte Interventionsstudien werden dringend benötigt.

Summary

Venous thromboembolism is the leading cause of pregnancy- associated morbidity and mortality. Women with thrombophilia have an increased risk of VTE in pregnancy and puerperium. In individuals with hereditary thrombosis risk factors a relative risk of pregnancy associated VTE ranging from 3.4 to 15.2 has been found. Women with previous VTE have an approximately 3.5-fold increased risk of recurrent VTE during pregnancy compared to non-pregnant periods.

Data on the association of thrombophilia and pregnancy loss and pre-eclampsia are conflicting. Besides an established association with antiphospholipid antibodies, available data suggest associations for antithrombin deficiency, hyperhomocysteinaemia, factor V Leiden, prothrombin G20210A variation and protein S-deficiency. A contribution of thrombophilia to the risk of pre-eclampsia is less well established. A limited number of prospective studies did not reveal an increased risk of pregnancy complications in unselected women with thrombosis risk factors. Data of only one controlled trial on the prevention of pregnancy loss with low molecular weight heparin (LMWH) are available, which revealed a strikingly positive effect. Thrombophilia screening might be justified in women with pregnancy loss and treatment with LMWH might be considered in those with pregnancy loss and thrombophilia. Further prospective studies and controlled interventional trials are urgently needed.

Schlüsselwörter

Thrombophilie - venöse Thrombose - Schwangerschaft - Abort - Präeklampsie

Keywords

Thrombophilia - venous thrombosis - pregnancy - fetal loss - abortion - pre-eclampsia

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