Effektivität und Sicherheit der niedermolekularen Heparine bei Schwangeren mit wiederholtem Spontanabort (> 3 Aborte). Vergleichsstudie mit intravenösen Immunglobulinen (IVIG)

Zusammenfassung

Studiendesign: In einer retrospektiven Studie verglichen wir den Schwangerschaftsverlauf von 117 Frauen mit Thrombophilie und 117 Frauen ohne Thrombophilie, anatomische und genetische Ursachen (immunologisch bedingter Abort) nach > 3 Aborten. Methoden: Die Frauen mit Thrombophilie erhielten 5000 IE Dalteparin täglich oder in Kombination mit 100 mg Aspirin ab Diagnosestellung der Schwangerschaft. Schwangere mit immunologisch bedingten Aborten gaben wir 0,2 g/kg Immunglobuline bis maximal der 30. SSW. Die Gabe von Aspirin wurde in der 35. SSW beendet; Dalteparin verabreichten wir bis zur Geburt und bis 6 Wochen post partum. Wir erfassten die Häufigkeit der Fehlgeburten, die späten Schwangerschaftskomplikationen (Frühgeburt, fetale Retardierung, Präeklampsie) sowie die Nebenwirkungen der Therapien. Resultate: Die Lebendgeburtsrate in der IVIG-Gruppe war mit 85 % vergleichbar mit der Thrombophilie-behandelten Gruppe (78,6 %). Spät auftretende Komplikationen lagen in der IVIG-Gruppe bei 21,6 % und in der Thrombophilie-Gruppe bei 47,9 %. Die substanzspezifischen Nebenwirkungen sahen wir selten. Schlussfolgerung: Eine Dosisanpassung des Dalteparin war im Verlauf der Schwangerschaften nicht notwendig, da die Anti-Xa-Spiegel unverändert blieben.

Abstract

Objective: To compare the most efficacious therapeutic regimes - intravenous immunoglobulin (IVIG), low molecular weight heparins (LMWH) or LMWH and aspirin - in cases with thrombophilia or antiphospholipid syndrome (APLS) in women prone to immunological abortion and women with a history of recurrent spontaneous abortion (> 3 abortions). Methods: We observed 117 women with > 3 abortions and thrombophilia and 117 women with the same history and immunological abortion. The women received Dalteparin 5000 anti-Xa units alone or in combination with 100 mg aspirin. The other group received 0.2 mg/kg IVIG every 4 weeks until the 30th week of gestation. Aspirin was stopped in the 35th week of gestation and LMWH shortly before delivery and continued up to 6 weeks after delivery. The incidence of abortion, the late pregnancy outcome and the side effects of LMWH and IVIG were recorded. Results: The characteristics of both groups were similar with respect to general parameters. The birth rate in the IVIG group was comparable (85.0 %) to the thrombophilia group (78.8 %). The pregnancy complication rate was higher in the group with thrombophilia (47.9 %) vs. IVIG (21.6 %). Conclusions: The study indicates that IVIG may prevent miscarriages in patients in whom of thrombophilic, anatomical and genetic factors were excluded. Dalteparin is safe and effective for the prevention of miscarriage in cases with hereditary thrombophilic defects and APLS. The anti-Xa values remained unchanged during pregnancy and a dosage adaptation was not needed. Side effects of Dalteparin and IVIG were rare.

Schlüsselwörter

Angeborene thrombophile Defekte - Antiphospholipid‐Syndrom - wiederholter Spontanabort (WSA) - intravenöse Immunglobuline (IVIG) - niedermolekulare Heparine (NMH) - Dalteparin

Key words

hereditary thrombophilia - antiphospholipid syndrome - recurrent spontaneous abortion - intravenous Immunoglobulin (IVIG) - low molecular weight heparin (LMWH) - Dalteparin

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