Guidelines for the use of low molecular heparin in pregnancy

Trudnoća je hiperkoagulabilno stanje koje dovodi do povećane učestalosti nastanka tromboembolija. Tromboembolijski poremećaji su ozbiljan problem u trudnoći jer mogu dovesti do različitih opasnih stanja, a na koncu i do smrti majke. Najveći rizik za nastanak venske tromboembolije (VTE) su prijašnje preboljene venske tromboze i nasljedne, odnosno stečene trombofilije. Venska tromboembolija najčešće se javlja u dva oblika – kao duboka venska tromboza (DVT) ili kao plućna embolija (PE). Prepoznavanje simptoma VTE-a tijekom trudnoće može biti teško zbog njihova preklapanja sa simptomima same trudnoće. U dijagnostici VTE-a pomažu laboratorijski nalazi, ultrazvuk i različite slikovne metode. Antikoagulantna terapija je indicirana kod profilakse i liječenja VTE-a, kod profilakse i liječenja VTE-a u žena sa stečenim i nasljednim trombofilijama, kod sprječavanja i liječenja nastanka komplikacija trudnoća u žena s trombofilijama i u ostalim stanjima s povećanim rizikom nastanka VTE-a. Iako nisu idealni zbog svojih nuspojava i načina primjene, heparini su lijekovi izbora antikoagulantne terapije za vrijeme trudnoće. Niskomolekularni heparin (NMH) se pokazao kao najbolji izbor terapije zbog rjeđih hemoragičnih epizoda, predvidljivijeg terapijskog odgovora te manjeg rizika od heparinom inducirane trombocitopenije i osteoporoze. Niskomolekularni heparini mogu se primjenjivati u standardnim dozama ili u dozama prilagođenim tjelesnoj masi kako bi se postigao željeni terapijski učinak.Pregnancy is a hypercoagulable state that leads to an increased frequency of thromboembolism. Thromboembolic disorders are a serious problem in pregnancy because they can lead to various dangerous conditions, and eventually to the death of the mother. The highest risk for venous thromboembolism (VTE) is a previous occurrence of VTE and inherited or acquired thrombophilia. Venous thromboembolism occurs most frequent in two forms: as deep vein thrombosis (DVT) or pulmonary embolism (PE). Recognizing VTE symptoms during pregnancy can be difficult because of the overlap of the symptoms with the symptoms of pregnancy itself. In the diagnostics of VTE laboratory findings, ultrasound and various imaging methods are used. Anticoagulant therapy is indicated for prophylaxis and treatment of VTE, for prophylaxis and treatment of VTE in women with hereditary thrombophilies, in preventing and treating pregnancy complications in women with thrombophilia and in other conditions with increased risk of VTE. Although not ideal because of their side effects and the way they are administered, heparins are the choice for anticoagulant therapy during pregnancy. Low molecular weight heparin (LMWH) proved to be the best choice of therapy due to uncommon hemorrhagic episodes, more predictable therapeutic response and a lower risk of heparin induced thrombocytopenia and osteoporosis. Low molecular weight heparins can be administered in standard doses or in doses adjusted to body weight to achieve the desired therapeutic effect