О крови и ненужности проверки Д-димера при беременности (за исключением)
Мнение специалиста из Хьюстона на уважаемом русмедсервисе.
полный вариант
ТУТ
Ретроспективный анализ из Хельсинки показывает, что назначение низкомолекулярных гепаринов (фраксипарина и тп.) во время беременности не уменьшает ни риск преждевременных родов, ни мертворождения, ни задержки внутриутробного развития, ни преэклампсии, в полтора раза повышает частоту антенатального кровотечения - поэтому данные препараты должны назначаться только по показаниям (лечение-профилактика тромбоза, привычное невынашивание при АФС), а не для улучшения кровотока в плаценте, разжижения густой крови при беременности, снижения Д-димера, РКМФ и тп.
648 pregnancies exposed to LMWH were compared with 626 unexposed pregnancies.
The incidence rates of various pregnancy complications did not differ between the groups
(LMWH group vs control group):
1.56% vs 1.1% for thrombocytopenia,
8.7% vs 6.5% for preterm delivery,
0.7% vs 0.3% for stillbirth,
1.4% vs 1.0% for severe pre-eclampsia,
2.7% vs 2.2% for foetal growth restriction, and
10.7% vs 7.8% for antenatal bleeding.
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Galambosi PJ, Kaaja RJ, Stefanovic V, Ulander VM. Safety of low-molecular-weight heparin during pregnancy: a retrospective controlled cohort study. Eur J Obstet Gynecol Reprod Biol. 2012 Aug;163(2):154-9.
отрывки из нижеприведенной статьи показывают, что назначение низкомолекулярного гепарина у беременных женщин с тромбофилией не препятствует росту Д-димера и др. показателей активации свертывания по сравнению с контролем:
...patients at high risk of pregnancy complications with confirmed thrombophilia are randomized to receive either dalteparin (5,000 units/day until 20 weeks then 5,000 units q12h until 37 weeks or onset of labor) or no treatment... dalteparin had no significant effects on the levels of thrombin-antithrombin complexes (TAT), prothrombin fragments 1 + 2 and D-dimer throughout pregnancy in thrombophilic women.
The effect of dalteparin on coagulation activation during pregnancy in women with thrombophilia. A randomized trial.
Abou-Nassar K, Kovacs MJ, Kahn SR, Wells P, Doucette S, Ramsay T, Clement AM, Khurana R, Mackinnon K, Blostein M, Solymoss S, Kingdom J, Sermer M, Rey E, Rodger M; TIPPS investigators.
Thromb Haemost. 2007 Jul;98(1):163-71.
449 women with at least 2 consecutive early miscarriages or 1 late miscarriage were included during 5 to 8 weeks' gestation after a viable pregnancy was confirmed by ultrasonography.
Women in the control group received multivitamin pills, and the intervention group received vitamins and 5000 IU of dalteparin-sodium for up to 24 weeks' gestation.
At 24 weeks' gestation, 191 of 220 pregnancies (86.8%) and 188 of 214 pregnancies (87.9%) were intact in the intervention and control groups, respectively (absolute difference, -1.1 percentage points [95% CI, -7.4 to 5.3 percentage points]). The live-birth rates were 86.0% (185 of 215 women) and 86.7% (183 of 211 women) in the intervention and control groups, respectively (absolute difference, -0.7 percentage point [CI, -7.3 to 5.9 percentage points]).