DMAH tedavisi altında tekrarlayan derin ven trombozu

Derin ven trombozu (DVT), alt veya üst ekstremite derin venlerinin trombozisi olarak tanımlanabilir. Tanı da ilk basamak renkli doppler ultrasonografi (DUSG) yer almaktadır. Tedavinin temelini antikoagülasyon oluşturmaktadır. Bu vakada tedavi edici dozlarda düşük molekül ağırlıklı heparin (DMAH) almasına rağmen tekrarlayan venöz tromboemboli (VTE) atakları olmuştur. Trombofili hastalarında gebelik ve loğusalık döneminde, tekrarlayan VTE’lerin önlenmesi için anti-Xa düzeylerine göre DMAH doz ayarı yapılması düşünülmelidir.

Anahtar Kelimeler:

Derin ven trombozu, DMAH, anti-Xa

Recurrent deep vein thrombosis under LMWH treatment

___

Kaynaklar 1. Liu S, Rouleau J, Joseph KS, Sauve R, Liston RM, Young D, Kramer MS. Epidemiology of pregnancy-associated venous thromboembolism: a population-based study in Canada. J Obstet Gynaecol Can 2009;31:611– 620.
2. Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005;143:697–706.
3. O’Connor DJ, Scher LA, Gargiulo NJ 3rd, Jang J, Suggs WD, Lipsitz EC. Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: a contemporary series. Ann Vasc Surg 2011;25:9–14.
4. Rutherford SE, Phelan JP. Deep venous thrombosis and pulmonary embolism in pregnancy. Obstet Gynecol Clin North Am 1991;18:345–370.
5. Sullivan EA, Ford JB, Chambers G, Slaytor EK. Maternal mortality in Australia, 1973–1996. Aust N Z J Obstet Gynaecol 2004;44:452–457; discussion 377.
6. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008;359:2025–2033.
7. Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Thrombosis And Embolism During Pregnancy and the Puerperium. Greentop Guideline No. 37a: 2009.
8. Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):844S–886S.
9. Barbour LA, Oja JL, Schultz LK. A prospective trial that demonstrates that dalteparin requirements increase in pregnancy to maintain therapeutic levels of anticoagulation. Am J Obstet Gynecol 2004;191:1024–1029.
10. Friedrich E, Hameed AB. Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy. J Perinatol 2010;30:253–257.