Danaparoid in der Schwangerschaft bei Heparinunverträglichkeit

 

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Zusammenfassung

Unter Therapie mit unfraktioniertem oder niedermolekularem Heparin treten häufig unerwünschte Arzneimittelwirkungen auf, die eine Fortsetzung der Therapie unmöglich machen. Insbesondere bei Schwangeren mit thromboembolischen Komplikationen kann es schwierig sein, ein geeignetes alternatives Antikoagulans zu finden, wenn zusätzlich eine Heparinunverträglichkeit vorliegt. Für den Einsatz von Danaparoid in der Schwangerschaft gibt es nur wenige Daten. Die Hauptgründe in den untersuchten 59 Schwangerschaften für eine Heparinunverträglichkeit waren entweder eine HIT II bei 37/59 (62,7%) Schwangeren, oder eine kutane Nebenwirkung in 19/22 (86,4%) der nicht HIT-assoziierten Schwangerschaften (22/59, 37,3%). Ergebnisse: 40/59 Schwangerschaften konnten unter Danaparoid erfolgreich ausgetragen werden, bei 16/19 wurde die Therapie aufgrund unerwünschter Arzneimittelwirkungen beendet. Fünf Patientinnen zeigten Blutungskomplikationen, die ebenso wenig Danaparoid-assoziiert waren wie die berichteten sechs Aborte und eine Abruptio. In 31/59 (52,5%) Schwangerschaften traten unerwünschte Arzneimittelwirkungen auf, 14/31 (45,2%) ließen sich auf Danaparoid zurückführen. In fünf Nabelschnurblut- und vier Brustmilchproben konnte keine Anti- Xa-Aktivität gemessen werden. Schlussfolgerung: Danaparoid kann zur alternativen Antikoagulation bei Schwangeren mit hohem Thromboserisiko und Heparinunverträglichkeit eingesetzt werden.

Summary

During the use of fractionated or unfractionated heparin adverse events frequently occur that can endanger the continuation of therapy. Especially in pregnant patients with thromboembolic complications it may be difficult to find a suitable alternative anticoagulant when heparin-induced thrombocytopenia type II (HIT II) or allergic skin reactions occur. There are still limited data on the use of danaparoid in pregnancy. The main reason for heparin intolerance in the 59 reviewed pregnancies were either HIT II, described in 37/59 (62.7%) pregnancies, or cutaneous adverse effects in 19/22 (86.4%) of non-HIT-associated pregnancies (22/59, 37.3%). Results: 40/59 pregnancies were carried to term under use of danaparoid and resulted in the delivery of a healthy infant. In 16/19 pregnancies, danaparoid was stopped due to a major adverse event. Five patients showed bleeding complications, seven fetal losses were documented, but there was no association with the use of danaparoid. In 31/59 (52.5%) pregnancies adverse events were documented, 14/31 (45.2%) could be attributed to danaparoid. Anti-Xa-activity was not detected in five fetal cord blood samples and in four maternal breastmilk samples. Conclusion: Danaparoid can be used as an alternative anticoagulant in pregnant women with high risk for thrombosis and heparin intolerance.

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