Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Тромбопрофилактика в акушерстве: кому, когда и чем?
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
В статье освещены актуальные вопросы применения антикоагулянтов (нефракционированного и низкомолекулярного гепарина) для профилактики венозных тромбоэмболических осложнений в акушерской практике. Приведена оценка факторов риска в зависимости от этапа беременности и родоразрешения, сопутствующей патологии и показания к назначению фармакологической тромбопрофилактики; профилактические и лечебные дозы нефракционированного и низкомолекулярного гепарина. Применение антикоагулянтов на этапе родоразрешения требует особого внимания вследствие риска развития геморрагических осложнений во время операции и нейроаксиальной аналгезии/анестезии. Применение фармакологической тромбопрофилактики должно проводиться в соответствии с современными протоколами.
Ключевые слова: гепарин, низкомолекулярный гепарин, венозная тромбоэмболия.
Ключевые слова: гепарин, низкомолекулярный гепарин, венозная тромбоэмболия.
________________________________________________
The article highlights the current issues of the use of anticoagulants (unfractionated and low molecular weight heparin) for the prevention of venous thromboembolic complications in obstetric practice. The assessment of risk factors, depending on the stage of pregnancy and delivery, comorbidities and indications for pharmacologic thromboprophylaxis; preventive and therapeutic doses of unfractionated and low molecular weight heparin. The use of anticoagulants on delivery stage requires special attention, due to the risk of hemorrhagic complications during surgery and neuraxial analgesia/anesthesia. The use of pharmacological thromboprophylaxis should be in accordance with current protocols.
Key words: heparin, low molecular weight heparin, venous thromboembolism.
Полный текст
Список литературы
1. Макацария А.Д. Антифосфолипидный синдром в акушерской практике. М.: Руссо, 2002.
2. Макацария А.Д. Системные синдромы в акушерско-гинекологической клинике. М.: Медицинское информационное агентство, 2010.
3. Макацария А.Д., Бицадзе В.О., Акиньшина С.В. Тромбозы и тромбоэмболии в акушерско-гинекологической клинике. М.: Медицинское информационное агентство, 2007.
4. Макацария А.Д., Мищенко А.С., Бицадзе В.О. Синдром диссеминированного внутрисосудистого свертывания (ДВС) крови в акушерской практике. М.: Триада-Х, 2006.
5. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология. 2010; 4 (2): 6–27.
6. American College of Obstetricians and Gynecologists (ACOG). Inherited thrombophilias in pregnancy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG), 2010.
7. American College of Obstetricians and Gynecologists Thromboembolism in Pregnancy Practice Bulletin Number 123, September 2011.
8. Bagaria SJ, Bagaria VB. Strategies for Diagnosis and Prevention of Venous Thromboembolism during Pregnancy. J Pregnancy 2011; 206858.
9. Bates SM, Greer IA, Pabinger I et al. American College of Chest Physicians. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133 (Suppl. 6): 844S–886S.
10. Bates SM. Pregnancy-associated venous thromboembolism: prevention and treatment. Semin Hematol 2011; 48 (4): 271–84.
11. Chan WS. Venous thromboembolism in pregnancy. Expert Rev Cardiovasc Ther 2010; 8 (12): 1731–40.
12. Conard J, Horellou MH, Samama MM. American College of Chest Physicians (ACCP). Pregnancy and venous thromboembolism. North-American and European guidelines. American College of Chest Physicians. J Mal Vasc 2009; 34 (5): 300–13.
13. Fogerty AE, Connors JM. Treating venous thromboembolism in pregnancy. Hematol Oncol Clin North Am 2011; 25 (2): 379–91.
14. Gray G, Nelson-Piercy C. Thromboembolic disorders in obstetrics. Best Pract Res Clin Obstet Gynaecol 2012; 26 (1): 53–64. Epub 2011.
15. High risk pregnancy. Management options/edition D.K.James, P.J.Steer et al. 4th ed. Mosby Elsevier Inc 2011.
16. Horlocker TT, Wedel DJ, Rowlingson JC et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35 (1): 64–101.
17. James A. Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011; 118 (3): 718–29.
18. James AH. Pregnancy and thrombotic risk. Crit Care Med 2010; 38 (Suppl. 2): S57–63.
19. Kesteven P, Hanley J, Loughney AD. Pregnancy-associated venous thrombosis. Phlebology 2012; 27 (Suppl. 2): 73–80.
20. Lussana F, Coppens M, Cattaneo M, Middeldorp S. Pregnancy-related venous thromboembolism: Risk and the effect of thromboprophylaxis. Thromb Res 2012; 129 (6): 673–80.
21. Marik PE. Venous thromboembolism in pregnancy. Clin Chest Med 2010; 31 (4): 731–40.
22. Martineau M, Nelson-Piercy C. Venous thromboembolic disease and pregnancy. Postgrad Med J 2009; 85 (1007): 489–94.
23. McLintock C, Brighton T, Chunilal S et al. Councils of the Society of Obstetric Medicine of Australia and New Zealand; Australasian Society of Thrombosis and Haemostasis. Recommendations for the prevention of pregnancy-associated venous thromboembolism. Aust N Z J Obstet Gynaecol 2012; 52 (1): 3–13.
24. Okoroh EM, Azonobi IC, Grosse SD et al. Prevention of venous thromboembolism in pregnancy: a review of guidelines, 2000–2011. J Womens Health (Larchmt) 2012; 21 (6): 611–5.
25. Pajor A. Thromboembolism and antithrombotic management in pregnancy. Orv Hetil 2011; 152 (21): 815–21.
26. Royal College of Obstetricians and Gynaecologists. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium Green-top Guideline No. 37a. November 2009.
27. Bates SM, Greer IA, Middeldorp S et al. VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 2): e691S-e736S; doi:10.1378/chest.11-2300
28. Sultan AA, West J, Tata LJ et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012; 156 (3): 366–73.
29. Schoenbeck D, Nicolle A, Newbegin K et al. The use of a scoring system to guide thromboprophylaxis in a high-risk pregnant population. Thrombosis 2011; 2011: 652796.
30. Moliterno DJ et al. Therapeutic Advances in Thrombosis/edit. 2nd Ed. Wiley 2013.
31. Tooher R, Gates S, Dowswell T, Davis LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2010; 5: CD001689.
2. Макацария А.Д. Системные синдромы в акушерско-гинекологической клинике. М.: Медицинское информационное агентство, 2010.
3. Макацария А.Д., Бицадзе В.О., Акиньшина С.В. Тромбозы и тромбоэмболии в акушерско-гинекологической клинике. М.: Медицинское информационное агентство, 2007.
4. Макацария А.Д., Мищенко А.С., Бицадзе В.О. Синдром диссеминированного внутрисосудистого свертывания (ДВС) крови в акушерской практике. М.: Триада-Х, 2006.
5. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология. 2010; 4 (2): 6–27.
6. American College of Obstetricians and Gynecologists (ACOG). Inherited thrombophilias in pregnancy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG), 2010.
7. American College of Obstetricians and Gynecologists Thromboembolism in Pregnancy Practice Bulletin Number 123, September 2011.
8. Bagaria SJ, Bagaria VB. Strategies for Diagnosis and Prevention of Venous Thromboembolism during Pregnancy. J Pregnancy 2011; 206858.
9. Bates SM, Greer IA, Pabinger I et al. American College of Chest Physicians. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133 (Suppl. 6): 844S–886S.
10. Bates SM. Pregnancy-associated venous thromboembolism: prevention and treatment. Semin Hematol 2011; 48 (4): 271–84.
11. Chan WS. Venous thromboembolism in pregnancy. Expert Rev Cardiovasc Ther 2010; 8 (12): 1731–40.
12. Conard J, Horellou MH, Samama MM. American College of Chest Physicians (ACCP). Pregnancy and venous thromboembolism. North-American and European guidelines. American College of Chest Physicians. J Mal Vasc 2009; 34 (5): 300–13.
13. Fogerty AE, Connors JM. Treating venous thromboembolism in pregnancy. Hematol Oncol Clin North Am 2011; 25 (2): 379–91.
14. Gray G, Nelson-Piercy C. Thromboembolic disorders in obstetrics. Best Pract Res Clin Obstet Gynaecol 2012; 26 (1): 53–64. Epub 2011.
15. High risk pregnancy. Management options/edition D.K.James, P.J.Steer et al. 4th ed. Mosby Elsevier Inc 2011.
16. Horlocker TT, Wedel DJ, Rowlingson JC et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35 (1): 64–101.
17. James A. Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011; 118 (3): 718–29.
18. James AH. Pregnancy and thrombotic risk. Crit Care Med 2010; 38 (Suppl. 2): S57–63.
19. Kesteven P, Hanley J, Loughney AD. Pregnancy-associated venous thrombosis. Phlebology 2012; 27 (Suppl. 2): 73–80.
20. Lussana F, Coppens M, Cattaneo M, Middeldorp S. Pregnancy-related venous thromboembolism: Risk and the effect of thromboprophylaxis. Thromb Res 2012; 129 (6): 673–80.
21. Marik PE. Venous thromboembolism in pregnancy. Clin Chest Med 2010; 31 (4): 731–40.
22. Martineau M, Nelson-Piercy C. Venous thromboembolic disease and pregnancy. Postgrad Med J 2009; 85 (1007): 489–94.
23. McLintock C, Brighton T, Chunilal S et al. Councils of the Society of Obstetric Medicine of Australia and New Zealand; Australasian Society of Thrombosis and Haemostasis. Recommendations for the prevention of pregnancy-associated venous thromboembolism. Aust N Z J Obstet Gynaecol 2012; 52 (1): 3–13.
24. Okoroh EM, Azonobi IC, Grosse SD et al. Prevention of venous thromboembolism in pregnancy: a review of guidelines, 2000–2011. J Womens Health (Larchmt) 2012; 21 (6): 611–5.
25. Pajor A. Thromboembolism and antithrombotic management in pregnancy. Orv Hetil 2011; 152 (21): 815–21.
26. Royal College of Obstetricians and Gynaecologists. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium Green-top Guideline No. 37a. November 2009.
27. Bates SM, Greer IA, Middeldorp S et al. VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 2): e691S-e736S; doi:10.1378/chest.11-2300
28. Sultan AA, West J, Tata LJ et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012; 156 (3): 366–73.
29. Schoenbeck D, Nicolle A, Newbegin K et al. The use of a scoring system to guide thromboprophylaxis in a high-risk pregnant population. Thrombosis 2011; 2011: 652796.
30. Moliterno DJ et al. Therapeutic Advances in Thrombosis/edit. 2nd Ed. Wiley 2013.
31. Tooher R, Gates S, Dowswell T, Davis LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2010; 5: CD001689.
________________________________________________
1. Макацария А.Д. Антифосфолипидный синдром в акушерской практике. М.: Руссо, 2002.
2. Макацария А.Д. Системные синдромы в акушерско-гинекологической клинике. М.: Медицинское информационное агентство, 2010.
3. Макацария А.Д., Бицадзе В.О., Акиньшина С.В. Тромбозы и тромбоэмболии в акушерско-гинекологической клинике. М.: Медицинское информационное агентство, 2007.
4. Макацария А.Д., Мищенко А.С., Бицадзе В.О. Синдром диссеминированного внутрисосудистого свертывания (ДВС) крови в акушерской практике. М.: Триада-Х, 2006.
5. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология. 2010; 4 (2): 6–27.
6. American College of Obstetricians and Gynecologists (ACOG). Inherited thrombophilias in pregnancy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG), 2010.
7. American College of Obstetricians and Gynecologists Thromboembolism in Pregnancy Practice Bulletin Number 123, September 2011.
8. Bagaria SJ, Bagaria VB. Strategies for Diagnosis and Prevention of Venous Thromboembolism during Pregnancy. J Pregnancy 2011; 206858.
9. Bates SM, Greer IA, Pabinger I et al. American College of Chest Physicians. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133 (Suppl. 6): 844S–886S.
10. Bates SM. Pregnancy-associated venous thromboembolism: prevention and treatment. Semin Hematol 2011; 48 (4): 271–84.
11. Chan WS. Venous thromboembolism in pregnancy. Expert Rev Cardiovasc Ther 2010; 8 (12): 1731–40.
12. Conard J, Horellou MH, Samama MM. American College of Chest Physicians (ACCP). Pregnancy and venous thromboembolism. North-American and European guidelines. American College of Chest Physicians. J Mal Vasc 2009; 34 (5): 300–13.
13. Fogerty AE, Connors JM. Treating venous thromboembolism in pregnancy. Hematol Oncol Clin North Am 2011; 25 (2): 379–91.
14. Gray G, Nelson-Piercy C. Thromboembolic disorders in obstetrics. Best Pract Res Clin Obstet Gynaecol 2012; 26 (1): 53–64. Epub 2011.
15. High risk pregnancy. Management options/edition D.K.James, P.J.Steer et al. 4th ed. Mosby Elsevier Inc 2011.
16. Horlocker TT, Wedel DJ, Rowlingson JC et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35 (1): 64–101.
17. James A. Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011; 118 (3): 718–29.
18. James AH. Pregnancy and thrombotic risk. Crit Care Med 2010; 38 (Suppl. 2): S57–63.
19. Kesteven P, Hanley J, Loughney AD. Pregnancy-associated venous thrombosis. Phlebology 2012; 27 (Suppl. 2): 73–80.
20. Lussana F, Coppens M, Cattaneo M, Middeldorp S. Pregnancy-related venous thromboembolism: Risk and the effect of thromboprophylaxis. Thromb Res 2012; 129 (6): 673–80.
21. Marik PE. Venous thromboembolism in pregnancy. Clin Chest Med 2010; 31 (4): 731–40.
22. Martineau M, Nelson-Piercy C. Venous thromboembolic disease and pregnancy. Postgrad Med J 2009; 85 (1007): 489–94.
23. McLintock C, Brighton T, Chunilal S et al. Councils of the Society of Obstetric Medicine of Australia and New Zealand; Australasian Society of Thrombosis and Haemostasis. Recommendations for the prevention of pregnancy-associated venous thromboembolism. Aust N Z J Obstet Gynaecol 2012; 52 (1): 3–13.
24. Okoroh EM, Azonobi IC, Grosse SD et al. Prevention of venous thromboembolism in pregnancy: a review of guidelines, 2000–2011. J Womens Health (Larchmt) 2012; 21 (6): 611–5.
25. Pajor A. Thromboembolism and antithrombotic management in pregnancy. Orv Hetil 2011; 152 (21): 815–21.
26. Royal College of Obstetricians and Gynaecologists. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium Green-top Guideline No. 37a. November 2009.
27. Bates SM, Greer IA, Middeldorp S et al. VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 2): e691S-e736S; doi:10.1378/chest.11-2300
28. Sultan AA, West J, Tata LJ et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012; 156 (3): 366–73.
29. Schoenbeck D, Nicolle A, Newbegin K et al. The use of a scoring system to guide thromboprophylaxis in a high-risk pregnant population. Thrombosis 2011; 2011: 652796.
30. Moliterno DJ et al. Therapeutic Advances in Thrombosis/edit. 2nd Ed. Wiley 2013.
31. Tooher R, Gates S, Dowswell T, Davis LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2010; 5: CD001689.
Авторы
А.В.Куликов1, 4, Е.М.Шифман2, И.Б.Заболотских3, С.В.Синьков3, С.Р.Беломестнов4
1. ГБОУ ВПО Уральский государственный медицинский университет Минздрава России, Екатеринбург;
2. ГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф.Владимирского;
3. ГБОУ ВПО Кубанский государственный медицинский университет Минздрава России, Краснодар;
4. Областной перинатальный центр ГБУЗ Областная детская клиническая больница №1, Екатеринбург
1. ГБОУ ВПО Уральский государственный медицинский университет Минздрава России, Екатеринбург;
2. ГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф.Владимирского;
3. ГБОУ ВПО Кубанский государственный медицинский университет Минздрава России, Краснодар;
4. Областной перинатальный центр ГБУЗ Областная детская клиническая больница №1, Екатеринбург
________________________________________________
A.V.Kulikov, E.M.Schiffman, I.B.Zabolotskikh, S.V.Sinkov, S.R.Belomestnov
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.