Профилактика и лечение тромботических осложнений у беременных, рожениц и родильниц


DOI: https://dx.doi.org/10.18565/pharmateca.2020.6.100-104

Н.А. Габитова

Академия постдипломного образования, Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий Федерального медико-биологического агентства, кафедра акушерства и гинекологии, Москва
Своевременное и адекватное назначение антикоагулянтных препаратов в акушерстве – мультидисциплинарное направление, которое интенсивно развивается. Профилактика и терапия тромботических осложнений у беременных, рожениц и родильниц обсуждаются с позиции выбора препаратов, режима дозирования, возможности их замены и определения круга пациенток в различных клинических ситуациях. Низкомолекулярные гепарины сегодня служат препаратом выбора для профилактики и лечения венозных тромботических осложнений во время беременности и послеродовом периоде.
Ключевые слова: беременность, тромбоэмболические осложнения, низкомолекулярные гепарины, послеродовый период

Литература


1. Canobbio M.M., Warnes C.A., Aboulhosn J., et al. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2017;135(8):e50-e87. Doi: 10.1161/CIR.0000000000000458


2. Worldatlas. Countries with the oldest average mother’s age at first birth. https://www.worldatlas.com/articles/countries-with-the-highest-mother-s-mean-age-atfirst-birth.html (25 April 2017).


3. Khan K.S., Wojdyla D., Say L., Gulmezoglu A.M.,Van Look P.F. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066–74. Doi: 10.1016/S0140-6736(06)68397-9.


4. Elkayam U., Goland S., Pieper P.G., Silverside C.K. High-risk cardiac disease in pregnancy: Part i. J Am Coll Cardiol. 2016;68:396–410. Doi: 10.1016/j.jacc.2016.05.048.


5. Ormesher L., Simcox L.E., Tower C., Greer Т.А. «To test or not to test», the arguments for and against thrombophilia testing in obstetrics. Obstet Med. 2017;10(2):61–6. Doi: 10.1177/1753495X17695696.


6. Rodger M.A., Gris J.C., De Vries J.I.P., et al. Low-Molecular-Weight Heparin for Placenta-Mediated Pregnancy Complications Study Group. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomized controlled trials. Lancet. 2016;388(10060):2629–41. Doi: 10.1016/S0140-6736(16)31139-4.


7. Croles F.N., Nasserinejad K., Duvekot J.J., et al. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. BMJ. 2017;359:j4452. Doi: 10.1136/bmj.j4452.


8. Simcox L.E., Ormesher L., Tower C., Greer I.A. Thrombophilia and Pregnancy Complications. International journal of molecular sciences. 2015;16(12):28418–28. Published online 2015 Nov 30. Doi: 10.3390/ijms161226104.


9. De Swiet M. Maternal mortality: Confidential inquiries into maternal deaths in United Kingdom. Am J Obstet Gynecol. 2000;183:1271. Doi: 10.1016/s0002-9378(00)70324-3.


10. Gerhardt A., Scharf R.E., Greer I.A., Zotz R.B. Hereditary risk factors for thrombophilia and probability of venous thromboembolism during pregnancy and the puerperium. Blood. 2016;128(19):2343–49. Doi: 10.1182/blood-2016-03-703728.


11. Leffert L., Butwick A., Carvalho B., et al. Members of the SOAP VTE Taskforce. The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants. Anesth Analg. 2018;126(3):928–44. Doi: 10.1213/ANE.0000000000002530.


12. Galambosi P.J., Gissler M., Kaaja R.J. V-Matti Ulander Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohort-study. Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica. 2017;96:852–61.


13. Анестезия и интенсивная терапия пациенток, получающих антикоагулянты для профилактики и лечения венозных тромбоэмболических осложнений в акушерстве. Клинические рекомендации. Протоколы лечения. М. Письмо Минздрава РФ от 06.12.2018 № 15-4/1-/2-7862


14. Sultan A.A., Tata L.J., West J., et al. Risk factors for first venous thromboembolism around pregnancy: Apopulation-based cohort study from the United Kingdom. Blood 2013;121:3953–61. Doi: 10.1182/blood-2012-11-469551.


15. Roeters van Lennep J.E., Meijer E., Klumper F.J., et al. Prophylaxis with low-dose low-molecular-weight heparin during pregnancy and postpartum: Is it effective? J Thromb Haemost. 2011;9:473–80. Doi: 10.1111/j.1538-7836.2011.04186.x.


16. Greer I.A., Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: A systematic review of safety and efficacy. Blood. 2005;106:401–7. Doi: 10.1182/blood-2005-02-0626.


17. Van Hagen I.M., Roos-Hesselink J.W., Ruys T.P., et al. Pregnancy in women with a mechanical heart valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation. 2015;132:132–42. Doi: 10.1161/CIRCULATIONAHA.115.015242.


18. Xu Z., Fan J., Luo X., et al. Anticoagulation regimens during pregnancy in patients with mechanical heart valves: A systematic review and meta-analysis. Can J Cardiol. 2016;32:1248.e1–1248.9. Doi: 10.1016/j.cjca.2015.11.005.


19. D’Souza R., Ostro J., Shah P.S., et al. Anticoagulation for pregnant women with mechanical heart valves: A systematic review and meta-analysis. Eur Heart J. 2017;214:S351–S351. Doi: 10.1093/eurheartj/ehx032.


20. Bates S.M., Middeldorp S., Rodger M., et al. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41:92–128. Doi: 10.1007/s11239-015-1309-0.


21. Linkins L.A., Dans A.L., Moores L.K., et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 suppl):e495S–e530S. Doi: 10.1378/chest.11-2303.


22. RCOG. Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management. Green-top Guideline No 37b. Royal College of Obstetricians and Gynaecologists; 2015.


23. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. European Heart J. 2018;00:1–83. Doi: 10.1093/eurheartj/ehy340.


24. Профилактика венозных тромбоэмболических осложнений в акушерстве и гинекологии. Клинические рекомендации (протоколы лечения). М. Письмо Минздрава РФ от 27.05.2014. № 15-4/10/2-3792.


25. Stephenson M.L., Serra A.E., Neeper J.M., et al. A randomized controlled trial of differing doses of postcesarean enoxaparin thromboprophylaxis in obese women. J Perinatol. 2016;36:95–9. Doi: 10.1038/jp.2015.130.


26. Overcash R.T., Somers A.T., LaCoursiere D.Y. Enoxaparin dosing after cesarean delivery in morbidly obese women. Obstet Gynecol. 2015;125:1371–76. Doi: 10.1097/AOG.0000000000000873.


27. Goland S., Schwartzenberg S., Fan J., et al. Monitoring of anti-Xa in pregnant patients with mechanical prosthetic valves receiving lowmolecular-weight heparin: Peak or trough levels? J Cardiovasc Pharmacol Ther. 2014;19:451–56. Doi: 10.1177/1074248414524302.


28. Knight M. UKOSS. Antenatal pulmonary embolism: Risk factors, management and outcomes. BJOG. 2008;115:453–61. Doi: 10.1111/j.1471-0528.2007.01622.x.


29. Friedrich E., Hameed A.B. Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy. J Perinatol. 2010;30:253–57. Doi: 10.1038/jp.2009.164.


30. Ormesher L., Simcox L., Tower C., Greer I.A. Management of inherited thrombophilia in pregnancy. Womens Health (Lond). 2016;12(4):41–433. Doi: 10.1177/1745505716653702.


31. Leffert L., Butwick A., Carvalho B., et al.; members of the SOAP VTE Taskforce. The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants. Anesth Analg. 2018;126(3):928–44. Doi: 10.1213/ANE.0000000000002530.


32. Sauter T.C., Eberle B., Wuillemin W.A.,., et al. How I manage patients with anticoagulation-associated bleeding or urgent surgery. Swiss Med. Wkly. 2018;14:wl4598. Doi: 10.4414/smw.2018.14598.


33. van Veen J.J., Maclean R.M., Hampton K.K., et al. Protamine reversal of low molecular weight heparin: Clinically effective? Blood Coagul Fibrinolysis. 2011;22:565–70. Doi: 10.1097/MBC.0b013e3283494b3c.


34. van Aart L., Eijkhout H.W., Kamphuis J.S., et al. Individualized dosing regimen for prothrombin complex concentrate more effective than standard treatment in the reversal of oral anticoagulant therapy: An open, prospective randomized controlled trial. Thromb Res. 2006;118:313–20. Doi: 10.1016/j.thromres.2005.08.005.


35. Chai-Adisaksopha C., Hillis C., Siegal D.M., et al. Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. A systematic review and meta-analysis. Thromb Haemost. 2016;116:879–90. Doi: 10.1160/TH16-04-0266.


36. Cauldwell M., Steer P.J., Swan L., et al. The management of the third stage of labour in women with heart disease. Heart. 2017;103:945–51. Doi: 10.1136/heartjnl-2016-310607.


37. James A.H., Jamison M.G., Brancazio L.R., Myers E.R. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006;194:1311–15. Doi: 10.1016/j.ajog.2005.11.008.


38. Pomp E.R., Lenselink A.M., Rosendaal F.R., Doggen C.J. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost. 2008;6:632–37. Doi: 10.1111/j.1538-7836.2008.02921.x.


39. Louis S.G., Sato M., Geraci T., et al. Correlation of Missed Doses of Enoxaparin With Increased Incidence of Deep Vein Thrombosis in Trauma and General Surgery Patients. JAMA Surg. 2014;149(4):365–70. Doi: 10.1001/jamasurg.2013.3963.


Об авторах / Для корреспонденции


Автор для связи: Н.А. Габитова, д.м.н., профессор кафедры акушерства и гинекологии Академии постдипломного образования, Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий Федерального медико-биологического агентства, Москва, Россия; e-mail: gabitova_nataliya@mail.ru; ORCID: https://orcid.org/0000-0003-2278-2624; eLibrary SPIN: 4812-3600 
Адрес: 125371, Россия, Москва, Волоколамское ш., 91


Бионика Медиа