Ведение беременности при дефиците антитромбина III: обзор литературы и описание клинического случая

Работа посвящена проблеме ведения беременности при наиболее тромбогенной генетической тромбофилии - дефиците антитромбина III (AT-III). Проведен детальный анализ литературы и представлен разбор собственного клинического случая ведения беременности у пациентки с дефицитом AT-III, тромбоэмболией легочной артерии и привычным невынашиванием беременности в анамнезе. Пациентки с дефицитом AT-III относятся к группе высокого риска по развитию тромботических и акушерских осложнений, даже несмотря на терапевтические дозы антикоагулянтов. Показания к применению и режимы введения концентрата AT-III в настоящее время четко не определены. Контроль терапии низкомолекулярным гепарином в значительной степени затруднен, так как тест на определение анти-Ха активности является AT-III-зависимым. Помимо стандартных методов контроля антитромботической терапии, мы использовали тесты, характеризующие динамические параметры сгустка: тромбоэластограмму, тест генерации тромбина. Наибольший риск с точки зрения как тромботических, так и геморрагических осложнений у таких больных представляет период родов и послеродовый период, когда требуется изменение режима антикоагулянтной терапии с временной ее отменой и дополнительное введение концентрата AT-III.

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