[Prevention and therapy of deep venous thromboses in pregnancy]

This paper presents a review of the current status of prevention and treatment of thromboses in pregnancy and reports the author's own results. Thromboembolism prophylaxis during pregnancy is accomplished with low-dose heparin, and is recommended for patients with a history of thrombosis and/or embolism. Heparin does not permeate the placenta; therefore, long-term use of it in low doses does not involve a risk. Complication-free courses in 18 pregnancies during which low-dose heparin was administered by the author are described. In cases of manifest deep thrombosis in the iliofemoral vein during pregnancy it is advisable today to perform thrombectomy as an alternative to fibrinolysis. This is followed by continuous administration of heparin in a therapeutic doses. Primary heparin treatment is given for thromboses of the knee and lower leg. The individual therapeutic methods are compared on the basis of information in the literature and the author's personal experience with 34 cases. Coumarins should no longer be used during pregnancy. In view of the risk of osteoporosis under high-dose long-term heparinization, one should switch to coumarins as soon as possible post partum; the coumarins are only detectable in traces in the mother's milk. Deep thromboses during pregnancy can only be treated with some promise of success if there is optimal cooperation between gynecologist, hemostasiologist and, if necessary, a vascular surgeon.