狸篪屦耱忸, 汨礤觐腩汨  疱镳钿箨鲨 玛膻麇 襄疱麇睃 忮潴 疱鲥礴桊箦禧 磬篦睇 骟痦嚯钼 桤溧龛 吕  
秒噔磬 鲤蹊 骟痦嚯 暑眚嚓螓 项滹桉赅

闲我嚷我形塘我茸叛世 闲卧人朗胰世 衔乱涡哇 闲泡仕捞涎壬 婆唾韧 倚翁廖匀巳派


企疣怆邂 ..
泥蜞 矬犭桕圉梃 磬 襦轵: 2014-08-14
念耱箫磬 蜞赕 镥鬣蝽铋 忮瘃梃 骟痦嚯
绣琬戾 | 项腠 蝈犟 | 殃圜囹 PDF
狸篪屦耱忸, 汨礤觐腩汨 疱镳钿箨鲨. 2014; N2: c.11-16

绣琬戾:
皱朦 桉耠邃钼囗 铞屙赅 翦牝桠眍耱 镳铗桠铗痤灬铗梓羼觐 镳铘桦嚓蜩觇 镱怛铕睇 陷 驽睐桧 蝠铎犷翳腓彘. 锑蝈痂嚯 戾蝾潲. 橡钼邃屙 镳铖镥牝桠眍 觌桧梓羼觐 桉耠邃钼囗桢 篦囫蜩屐 66 镟鲨屙蝾 蝠铎犷翳腓彘 (沐礤蜩麇耜铋, 镳桀狃弪屙眍 桦 耦麇蜞眄铋) 陷 囗囔礤珏: 35 钺疣蜩怿桢 , 耦铗忮蝰蜮屙眍, 磬躅羼 镱 磬 磬犭屙桢 翦痱桦钽 鲨觌 (镱溷痼镲 Ia), 31 钺疣蜩怿桢 磬 箧 狍潴麒 徨疱戾眄 ( 6 镱 13 礤. 沐耱圉梃) IIa 镱溷痼镲. 暑眚痤朦眢 沭箫矬 耦耱噔桦 50 驽睐桧 礤铗泐眄 嚓篪屦耜瞽汨礤觐腩汨麇耜桁 蝠铎犷蜩麇耜桁 囗囔礤珙. 义疣镨 镳钼钿桦囫: 吞 (铌襦镟痂), 忤蜞扈睇 沭箫稃 , 囗蜩铌耔溧眚 扈牮铐桤桊钼囗睇 镳钽羼蝈痤. 绣珞朦蜞螓 桉耠邃钼囗: 镟鲨屙蝾, 镱塍鬣怿桴 蝈疣镨 翦痱桦钽 鲨觌, 蝈麇龛 徨疱戾眄铖蜩, 嚓篪屦耜桢 镥痂磬蜞朦睇 桉躅潲 猁腓 塍鼬, 麇 沭箫镥 镟鲨屙蝾, 蝈疣镨 觐蝾瘥 猁豚 磬鬣蜞 忸 怵屐 徨疱戾眄铖蜩. 青觌屙桢: 潆 镳邃铗怵帙屙 镱怛铕眍 陷 镳 镱耠邃簋 徨疱戾眄铖蜩 礤钺躅滂祛 磬麒磬螯 蝈疣镨 翦痱桦钽 鲨觌, 镳钿铍驵 忸 怵屐 徨疱戾眄铖蜩, 痤漕 镱耠屦钿钼铎 镥痂钿. 义疣镨 漕腈磬 怅膻鬣螯 吞, 忤蜞扈睇 沭箫稃 , 囗蜩铌耔溧眚 扈牮铐桤桊钼囗睇 镳钽羼蝈痤.


ANTITHROMBOTIC PROPHYLAXIS REPEATED PREECLAMPSIA IN PATIENTS WITH THROMBOPHILIA Zhuravleva E.V.
First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation
Abstract. Objective. To evaluate the efficiency of antithrombotic therapy to prevent repeated preeclampsia in patients with thrombophilia. Subject and methods. A prospective clinical study was conducted 66 patients with thrombophilia (genetic, acquired or concomitant) and with history of preeclampsia: 35 patients addressed and were followed since fertile cycle (subgroup Ia) and 31 patients addressed during pregnancy and were followed since 6-13 weeks of gestation IIa subgroup. Control group 50 patients without both obstetrics and gynecology and thrombotic complications in history. Therapy included LMWG (klexan), B vitamins, antioxidants and micronized progesterone. Results. The all period of pregnancy, obstetric and perinatal outcomes were better in patients receiving therapy since fertile cycle compared with group of patients whose therapy was initiated during pregnancy.Conclusion. To prevent re-PE at a subsequent pregnancy, the therapy should be start since fertile cycle, continuing during pregnancy, childbirth and the postpartum period. Therapy should include LMWH, B vitamins, antioxidants and micronized progesterone.
Key words: preeclampsia, antithrombotic therapy, LMWG, thrombophilia.


孰邂 耠钼: 镳妪觌囔锺, 镳铗桠铗痤灬铗梓羼赅 镳铘桦嚓蜩赅, 铌襦镟痂, 蝠铎犷翳腓.




昧斡 孪 屦恹 堂逃 桁屙 .. 彦麇眍忄 惕礴漯噔 性, 填耜忄

扬桉铌 耦牮帙屙栝
烂 囗蝈磬蜞朦磬 汨徨朦 镫钿; 滥 噤屙铉桧滂纛耵囹; 朗 囗蜩赅痄桀腓镨眍恹 囗蜩蝈豚; 酪 III 囗蜩蝠铎徼 III; 涝 囗蜩纛耵铍栾桎睇 囗蜩蝈豚; 涝 囗蜩纛耵铍栾桎睇 囗蜩蝈豚; 雷衣 嚓蜩忤痤忄眄铄 鬣耱梓眍 蝠铎犷镫囫蜩眍忸 怵屐; 吕 忸膑囗铟睇 囗蜩觐嚆箅眚; 掏 戾驿箜囵钿眍 眍痨嚯桤钼囗眍 铗眍龛; 吞 栱桤觐祛脲牦痦 沐镟痂睇; 衔托 镳彐溴怵屐屙磬 铗耠铋赅 眍痨嚯 疣耧铍铈屙眍 镫圉屙螓; 陷 镳妪觌囔锺; 亚滦 耔礓痤 玎溴疰觇 忭篁痂篁痤犴钽 疣玮栩 镫钿; 依 蝠铎徼憝囗蜩蝠铎徼眍恹 觐祜脲犟; 逸 蝠铎犷囫蝾沭圄; 佬 嚓蜩忤痤忄眄 镳铗彖 ; PAI-1 桧汨徼蝾 嚓蜩忄蝾疣 镫噻扈眍沐磬-1.



骡邃屙桢

耦怵屐屙眍 嚓篪屦耱忮 耦鲨嚯 珥圜桁铋 镳钺脲祛 怆 嚓篪屦耜桢 铖腩骓屙, 觐蝾瘥 镳桠钿 镳屦囗棹 徨疱戾眄铖蜩, 蜞赕 镱恹龛 箴钼 镥痂磬蜞朦眍 爨蝈痂眈觐 耢屦蝽铖蜩 [13]. 橡妪觌囔锺  镟蝾腩汨麇耜铄 耦耱龛, 囫耦鲨桊钼囗眍 徨疱戾眄铖螯, 觐蝾痤 踵疣牝屦桤箦蝰 汨镥痱屙玷彘, 镳铗彖眢痂彘 镱耠 20 礤. 沐耱圉桀眄钽 耩铌, 怦蝠鬻帼羼 镳桁屦眍 4% (铗 1,5 漕 10%) 耠篦噱 怦艴 徨疱戾眄铖蝈 怆邋 钿眍 桤 忮潴 镳梓桧 爨蝈痂眈觐 翦蜞朦眍 玎犷脲忄屐铖蜩 耢屦蝽铖蜩 [17]. 陷 怆弪 忄骓彘 镳梓桧铋 镥痂磬蜞朦眍 玎犷脲忄屐铖蜩 耢屦蝽铖蜩 扈疱 [14,15,16]. 需耜 镥痂磬蜞朦眍 耢屦蝽铖蜩 镳 溧眄铎 玎犷脲忄龛 筲咫梓桠噱蝰 5 疣 [3]. 痒栩噱蝰, 黩 陷 怆弪 镳梓桧铋 75 000 爨蝈痂眈觇 耢屦蝈 忸 怦屐 扈疱 彐邈钿眍 [12]. 朽聒桊屙桢 筱塍犭屙桢 珥囗栝 忸珈铈眍耱 耦怵屐屙眍 镳铘桦嚓蜩觇 陷 玎耠箧桠帼 镳桉蜞朦眍泐 忭桁囗.

80-90 沣. 照 . 钿桧 玎 漯筱桁 猁腓 铗牮 礤耜铍 沐礤蜩麇耜桴 纛痨 蝠铎犷翳腓, 怅膻鬣 祗蜞鲨 FV Leiden, 祗蜞鲨 镳铗痤灬桧 G20210, 镱腓祛痿桤禧 沐眍, 觐眚痤腓痼桴 耔耱屐 翳狃桧铍桤喹PAI-1, 4G/5G, 镱腓祛痿桤禧 蜿囗邂钽 嚓蜩忄蝾疣 镫噻扈眍沐磬 t-欣 I/D, 翳狃桧钽屙 455 A/G, 羿牝铕 XII .., 囗蜩纛耵铍栾桎睇 耔礓痤 (涝) [7,8]. 羊嚯 桤篦囹 痤朦 汨镥疸铎铞桉蝈桧屐梃 疣玮栩梃 囹屦铗痤灬铉 忮眍珥 蝠铎犷犷腓. 武眍怵屐屙眍 桉耠邃钼嚯囫 痤朦 沐礤蜩麇耜铋 镳桀狃弪屙眍 蝠铎犷翳腓 桀镟蝾沐礤珏 礤 蝾朦觐 蝠铎犷蜩麇耜桴, 眍 蜩镨黜 嚓篪屦耜桴 铖腩骓屙栝 镳妪觌囔锺梃, 礤恹磬忄龛 徨疱戾眄铖蜩, 耔礓痤爨 玎溴疰觇 痤耱 镫钿 (亚邢), 囗蝈磬蜞朦眍 汨徨腓 镫钿 (烂), 衔托, 铒疱溴桴 镥痂磬蜞朦眢 玎犷脲忄屐铖螯 耢屦蝽铖螯 [5,10,11]. 杨汶囫眍 溧眄 桉耠邃钼囗栝, 镳钼邃屙睇 镱 痼觐忸漶蜮铎 镳铘. .. 锑赅鲟痂, 蜞赕 溧眄 扈痤忸 腓蝈疣蝮瘥, 蜞觇 嚓篪屦耜桢 铖腩骓屙, 赅 陷, 耔礓痤 镱蝈痂 镫钿 70-77% 耠篦噱 囫耦鲨桊钼囗 祗朦蜩沐眄 耦麇蜞眄 纛痨囔 蝠铎犷翳腓 [1,2,6,9]. 袜 皴泐漤栝 溴睃 疱珞朦蜞螓 戾蜞囗嚯桤 镱玮铍 恹溴腓螯 沐礤蜩麇耜桢 镳桀狃弪屙睇 纛痨 蝠铎犷翳腓 襦祛耱蝈朦眢 沭箫矬 羿牝铕钼 痂耜 铖眍忭 嚓篪屦耜桴 铖腩骓屙栝 (陷, 耔礓痤 镱蝈痂 镫钿, 耔礓痤 玎溴疰觇 忭篁痂篁痤犴钽 痤耱 镫钿 镳.) [4]. 疋玷 桁 镥疱 磬篦睇 扈痤 怦蜞 忸镳铖 镱桉赅 眍恹 纛痨 镳铘桦嚓蜩觇 镱怛铕睇 铖腩骓屙栝 徨疱戾眄铖蜩, .. 陷. 篦屙 (. Rey, . Gamen, G. Fait, A. Many, M.J. Kupfermink, J.C. Gris, B. Brenner) 镳邃镳桧桁嚯 蜞觇 镱稃蜿 镱塍麒腓 忮顸爨 钺磬溴骅忄桢 疱珞朦蜞螓.

皱朦 磬 疣犷螓 铞屙赅 镳铗桠铗痤灬铗梓羼觐 镳铘桦嚓蜩觇 镱怛铕睇 陷 驽睐桧 蝠铎犷翳腓彘.

锑蝈痂嚯 戾蝾潲

袜扈 猁腩 钺耠邃钼囗 66 镟鲨屙蝾 蝠铎犷翳腓彘 (沐礤蜩麇耜铋, 镳桀狃弪屙眍 桦 耦麇蜞眄铋) 陷 囗囔礤珏, 忸澍桴 镳铖镥牝桠眢 沭箫矬: 35 镟鲨屙蝾 陷 囗囔礤珏, 钺疣蜩怿桢 , 耦铗忮蝰蜮屙眍, 磬躅羼 镱 磬 磬犭屙桢 翦痱桦钽 鲨觌 (镱溷痼镲 Ia), 31 镟鲨屙蜿 陷 囗囔礤珏, 钺疣蜩怿桢 磬 箧 狍潴麒 徨疱戾眄 ( 6 镱 13 礤. 沐耱圉梃) IIa 镱溷痼镲. 相鲨屙蜿 镱溷痼镲 Ia 猁腓 钺耠邃钼囗 觐眈箅桊钼囗 漕 徨疱戾眄铖蜩, 磬犭嚯桉 蝈麇龛 怦邈 沐耱圉桀眄钽 耩铌 镱耠 痤漕疣琊屮屙. 相鲨屙蜿 镱溷痼镲 II 猁腓 钺耠邃钼囗 漕 徨疱戾眄铖蜩 ( 疣礻圊 疱蝠铖镥牝桠眍 沭箫稃), 钿磬觐 磬犭嚯桉 腓 祛戾眚 桴 钺疣龛 磬 (箧 狍潴麒 徨疱戾眄, 磬 耩铌圊 铗 6 漕 13 礤.). 暑眚痤朦眢 沭箫矬 耦耱噔桦 50 驽睐桧 礤铖腩骓屙睇 蝈麇龛屐 徨疱戾眄铖蜩, 礤铗泐眄 嚓篪屦耜瞽汨礤觐腩汨麇耜桁 蝠铎犷蜩麇耜桁 囗囔礤珙. 袜 痂耋黻 1 镳邃耱噔脲 嚓篪屦耜栝 囗囔礤 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃.

需耋眍 1: 狸篪屦耜栝 囗囔礤 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃.需耋眍 1: 狸篪屦耜栝 囗囔礤 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃.


如 溧眄 滂嚆疣祆 忤漤, 黩 襦祛 鬣耱铋 嚓篪屦耜铋 镟蝾腩汨彘 溧眄铋 沭箫稃 镟鲨屙蝾 怆腓顸 亚邢 镳彐溴怵屐屙睇 痤潲 35 镟鲨屙蝾 (53%), 磬 怛铕铎 戾耱 镱 鬣耱铗 衔托 19 镟鲨屙蝾 (28,8%), 囗蝈磬蜞朦磬 汨徨朦 镫钿 猁豚 囗囔礤珏 6 镟鲨屙蝾, 黩 耦耱噔桦 9%, 蝠铎犷琨 镱耠屦钿钼铎 镥痂钿 怦蝠鬻嚯桉 囗囔礤珏 5 镟鲨屙蝾 (7,6%).

马 玎忤耔祛耱 铗 蜩镟 溴翦牝 沐祛耱噻, 怦屐 镟鲨屙蜿囔 忤溴 徉玷耥铋 蝈疣镨 磬珥圜嚯桉 镳铗桠铗痤灬铗梓羼觇 镳屣囵囹 ( 翦痱桦钽 鲨觌 沭箫镥 Ia, 祛戾眚 钺疣龛 沭箫镥 IIa). 圉弪桦襦腓鲨腩忄 觇耠铗 25-100 煦 玎忤耔祛耱 铗 趔黻鲨 蝠铎犷鲨蝾, 吞 铌襦镟痂 漕珏 0,2-1,0 祀 镱潢铈眍 ( 磬耱箫脲龛 徨疱戾眄铖蜩 沭箫镥 Ia, 祛戾眚 钺疣龛 沭箫镥 IIa). 疣礻圊 漕镱腠栩咫铋 蝈疣镨 怦 镟鲨屙蜿 镳铖镥牝桠眍 沭箫稃 镳桧桁嚯 忤蜞扈睇 沭箫稃 , 纛腓邂簋 觇耠铗 (礤 戾礤 4 煦 耋.) 赅麇耱忮 徉玷耥铋 蝈疣镨 ( 镟鲨屙蝾 汨镥泐祛鲨耱彖礤扈彘, 钺篑腩怆屙眍 磬腓麒屐 祗蜞鲨 MTHFR), 镱腓礤磬覃眄 骅痦 觇耠铗 (铎邈 3, 铎邈 6). 襄疱 磬珥圜屙桢 吞 钺玎蝈朦眍 镳铊玮钿桦铖 忧 鲥朦 篁铟礤龛 爨蝾黜铋 腩赅腓玎鲨 镫钿眍泐 轹 铗耋蝰蜮 篦囫蜿钼 铗耠铋觇 躅痂铐.

亦赕 镥疱 磬珥圜屙桢 铌襦镟痂磬, 玎蝈 麇疱 10 漤彘 溧脲 疣 戾 镳钼钿桦 觐眚痤朦 箴钼 爨痍屦钼 蝠铎犷翳腓 依, -滂戾疣, 桤戾腭 箴钼屙 泐祛鲨耱彖磬 镫噻戾, 趔黻鲨 镳铗彖磬 (镟痼癍蝈耱), 箴钼屙 PAI-1, 嚆疱汔鲨铐磬 嚓蜩忭铖螯 蝠铎犷鲨蝾, 黩 礤钺躅滂祛 潆 恹犷疣 噤尻忄蝽铋 漕琨 镳屣囵囹 觐眚痤 翦牝桠眍耱 徨珙镟耥铖蜩 镳桁屙屙 镳屣囵囹. 溧眄铋 沭箫稃 镟鲨屙蝾 猁豚 恹怆屙 镳钽羼蝈痤眍忄 礤漕耱囹铟眍耱 (忸珈铈磬 镳梓桧 觐蝾痤 鲨痍箅鲨 涝), 疋玷 麇 怦 铐 镱塍鬣腓 镳屣囵囹 扈牮铐桤桊钼囗眍泐 镳钽羼蝈痤磬 (200-800 忭篁瘘 忄汨磬朦眍) 怙腩螯 漕 24 礤. 徨疱戾眄铖蜩. 橡 铗耋蝰蜮梃 牮钼龛耱 恹溴脲龛 镳邃镱黩栩咫 桉镱朦珙忄螯 镳屣囵囹 忄汨磬朦眍 猁耱疣 噌耦疳鲨, 镥疴梓眍 镳铛铈溴龛 麇疱 漕戾蝠栝, 耥桄屙磬 觐眦屙蝠圉 钺 牮钼铗铌 铗耋蝰蜮桢 耔耱屐眍泐 溴轳蜮 磬 疣眄桴 耩铌圊 徨疱戾眄铖蜩. 昨 赅襦弪 囫镨痂磬, 蝾 溧眄 镳屣囵囹 磬珥圜嚯 玎忤耔祛耱 铗 鲨痍箅鲨 涝-觐羿牝铕钼, 镱腓祛痿桤爨 蝠铎犷鲨蜞痦 疱鲥矧铕钼 嚆疱汔鲨铐眍 嚓蜩忭铖蜩 蝠铎犷鲨蝾 扈龛-漕玎 75 煦 耋. 铌襦镟痂, 圉弪桦襦腓鲨腩忄 觇耠铗 磬珥圜嚯桉 疣礻圊 徉玷耥铋 蝈疣镨, 翦痱桦钽 鲨觌 (镳 磬腓麒 恹耦觇 箴钼礤 爨痍屦钼 蝠铎犷翳腓), 潆栩咫铖螯 漕琨 镳屣囵囹钼 觐痧尻蜩痤忄腓顸 玎忤耔祛耱 铗 耱屣屙 痂耜 蝠铎犷蜩麇耜桴 铖腩骓屙栝.

吞 镳桁屙腓顸 镱潢铈眍 1-2 疣玎 耋. 礤镳屦眍 疱骅戾 蝈麇龛 怦彘 徨疱戾眄铖蜩. 青 耋蜿 漕 赍襦疱忄 皴麇龛 镳屣囵囹 铗戾腭 鲥朦 镳铘桦嚓蜩觇 沐祛痧嚆梓羼觇 铖腩骓屙栝, 麇疱 8 镱耠 铒屦圉梃 蝈疣镨 忸珙犴钼豚顸 磬 10 漤彘, 镳 铎 镳钿铍骅蝈朦眍耱 蝈疣镨 祛汶 戾螯 玎忤耔祛耱 铗 耦耱龛 镟疣戾蝠钼 耔耱屐 沐祛耱噻. 义耱, 觐蝾瘥 镳桁屙腓顸 镳 铞屙赍 沐祛耱噻: 雷衣, 逸, 镳铗痤灬桧钼铄 怵屐.

绣珞朦蜞螓 桉耠邃钼囗

蜞犭桷 1 镳邃耱噔脲睇 疱珞朦蜞螓 桉躅漤铋 铞屙觇 耔耱屐 沐祛耱噻 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃.

亦犭桷 1. 绣珞朦蜞螓 桉躅漤铋 铞屙觇 耔耱屐 沐祛耱噻 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃 (盐 耱囗溧痱眍 铗觌铐屙桢).
项赅玎蝈朦 橡铖镥牝桠磬 沭箫镟 (n=66) 暑眚痤朦磬 沭箫镟 (n=50)
雷衣 (皴.), 耩邃礤 盐 27,33,1 27,10,5
橡铗痤灬桧钼铄 怵屐 (皴.), 耩邃礤 盐 1037,5 10111,7
茵铎徼眍忸 怵屐 (皴.), 耩邃礤 盐 181 17,12,3
澡狃桧钽屙 (/), 耩邃礤 盐 40,5 3,50,3
酪 III, 耩邃礤 盐 112,520 114,820
r+k (皴.), 耩邃礤 盐 193 210,5
ma (祆), 耩邃礤 盐 503,2 47,52,8
纫 (..), 耩邃礤 盐 334 282
楞疱汔鲨 蝠铎犷鲨蝾 滥 1×103M(%), 耩邃礤 盐 515 382
楞疱汔鲨 蝠铎犷鲨蝾 痂耱铎桷桧铎 1×103M(%), 耩邃礤 盐 503 401,5
绣玷耱屙蝽铖螯 佬 (囵篑-蝈耱), n(%) 5 (7,6%) 1 (2%)
D-滂戾 (礻/祀), 耩邃礤 盐 2,10,5 0,50,5


绣珞朦蜞螓 桉耠邃钼囗 耱痼牝箴 蝠铎犷翳腓麇耜桴 磬痼龛 漕 磬珥圜屙 吞 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃 镳邃耱噔脲睇 蜞犭桷 2.

亦犭桷 2. 羊痼牝箴 蝠铎犷翳腓麇耜桴 磬痼龛 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃 漕 蝈疣镨 吞.
项赅玎蝈朦 相鲨屙蜿 镳铖镥牝桠眍 沭箫稃 (n=66)
-滂戾 35 (53%)
38 (57,5%)
吕 (+) 10 (15,2%)
妙祛鲨耱彖 11 (16,7%)
理蜩弪-2-GP-1 12 (18,2%)
理蜩镳铗痤灬桧钼 囗蜩蝈豚 8 (12%)
理蜩蝈豚 囗礤犟桧 V 5 (7,6%)
25 (37,9%)
PAI-1 35 (53%)
楞疱汔鲨铐磬 嚓蜩忭铖螯 41 (62,1%)


亦觇 钺疣珙, 镟疣戾蝠圊 沐祛耱噻桀沭囔禧 桉耠邃钼囗睇 镟鲨屙蝾 猁腓 耠邃簋 桤戾礤龛: 镱恹龛 -滂戾疣 铗戾鬣腩顸 犷脲 麇 镱腩忤睇 镟鲨屙蝾 (53%), 镱恹龛 箴钼 觐祜脲犟 依 57,5%, 嚆疱汔鲨铐磬 嚓蜩忭铖螯 蝠铎犷鲨蝾 62,1%, 吕 恹怆腭 10 (15,2%) 镟鲨屙蝾, 镱恹龛 箴钼 PAI-1 53% 耠篦噱. 项恹眄铋 沐祛痧嚆梓羼觐 磬觌铐眍耱 礤 猁腩 恹怆屙 龛 钿眍 镟鲨屙蜿. 蜩 镟鲨屙蝾, 囗囔礤珏 觐蝾瘥 猁腓 蝠铎犷琨 镱耠屦钿钼铎 镥痂钿, 箴钼龛 溧眄 爨痍屦钼 猁腓 耩噔龛蝈朦眍 恹, 疋玷 麇 漕琨 吞 磬珥圜嚯桉 犷脲 恹耦觇. 橡梓屐 磬 溧眄铋 蝈疣镨 III 蝠桁羼蝠 箴钼龛 爨痍屦钼 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃 猁腓 耦镱耱噔桁 蜞觐恹扈 镟鲨屙蝾 觐眚痤朦眍 沭箫稃. 朽耨祛蝠桁  滂磬扈牦 磬 镳桁屦 -滂戾疣 (耢. 痂. 2), 蜞赕 嚆疱汔鲨铐眍 嚓蜩忭铖蜩 蝠铎犷鲨蝾 (耢. 痂. 3).

需耋眍 2: 蔫磬扈赅 箴钼  - 滂戾疣 镱耠 磬珥圜屙 吞 (磬 10- 溴睃).需耋眍 2: 蔫磬扈赅 箴钼 - 滂戾疣 镱耠 磬珥圜屙 吞 (磬 10- 溴睃).


需耋眍 3: 蔫磬扈赅 嚆疱汔鲨铐眍 嚓蜩忭铖蜩 蝠铎犷鲨蝾 镱耠 磬珥圜屙 蝈疣镨 (磬 10- 溴睃).需耋眍 3: 蔫磬扈赅 嚆疱汔鲨铐眍 嚓蜩忭铖蜩 蝠铎犷鲨蝾 镱耠 磬珥圜屙 蝈疣镨 (磬 10- 溴睃).


亦赕 镱耠 磬珥圜屙 吞 铗戾鬣腩顸 耥桄屙桢 箴钼礤 涝-觐羿牝铕钼, 箴钼礤 囗蜩蝈 镳铗痤灬桧, 囗礤犟桧 V, 徨蜞-2GP-1 (耢. 痂. 4). 亦觐忄 猁豚 滂磬扈赅 铗眍龛 泐祛鲨耱彖磬.

需耋眍 4: 蔫磬扈赅 耥桄屙 箴钼 涝 - 觐羿牝铕钼  镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃 磬 纛礤 蝈疣镨.需耋眍 4: 蔫磬扈赅 耥桄屙 箴钼 涝 - 觐羿牝铕钼 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃 磬 纛礤 蝈疣镨.


项扈祛 祛龛蝾痂磴 豚犷疣蝾痦 溧眄, 镟鲨屙蜿囔 镳铖镥牝桠眍 沭箫稃 镳钼钿桦 觐眚痤朦 翦牝桠眍耱 蝈疣镨 觌桧桕瞽趔黻鲨铐嚯 戾蝾溧扈. 袜镳桁屦, 潆 铞屙觇 耦耱龛 爨蝾黜瞽镫圉屙蜞痦钽 镫钿钼瞽镫圉屙蜞痦钽 牮钼铗铌 磬 耩铌 30-32, 34-36 38 礤. 镳钼钿桦铖 忧 漕镲脲痤戾蝠桢.

疱珞朦蜞蝈 蝈麇龛 桉躅潲 徨疱戾眄铖蝈 镟鲨屙蝾 溧眄铋 沭箫稃 猁腓 耠邃簋扈 (耢. 蜞犭. 3): 亚滦 磬犭嚯铖 7 镟鲨屙蝾 桤 沭箫稃, 2 镟鲨屙蝾 桤 镱溷痼镲 I 5 IIa 镱溷痼镲. 鱼痤玎 镳屦囗 徨疱戾眄铖蜩 镳铖镥牝桠眍 沭箫镥 镟鲨屙蝾 猁豚 6 (9,1%): 1 (2,9%) 6 (16,1%) 镱溷痼镲圊 Ia IIa, 耦铗忮蝰蜮屙眍. 念耩铟眍泐 痤漕疣琊屮屙 Ia 镱溷痼镲 礤 猁腩 龛 钿眍 镟鲨屙蜿, 镱溷痼镲 II 2 (6,5%), 觐眚痤朦眍 沭箫镥 蜞赕 礤 猁腩 龛 钿眍 镟鲨屙蜿. 蓐耱疱眄钽 赍襦疱忄 皴麇龛 礤 镳铊玮钿桦铖 龛 钿眍 镟鲨屙蜿: 龛 镳铖镥牝桠眍 沭箫稃, 龛 沭箫稃 觐眚痤. 缅耱铉 脲汴铋 耱屣屙 桁咫 戾耱 镟鲨屙蝾 Ia, IIa 觐眚痤朦眍 沭箫 1 (2,9%); 6 (16,1%) 5 (10%) 耦铗忮蝰蜮屙眍. 朽耧屦邃咫屙桢 溧眄 镱 沐耱铉 耩邃礤 耱屣屙 驽耱: 0; 2 (6,5%); 0 耦铗忮蝰蜮屙眍. 陷 耩邃礤 驽腩 耱屣屙彘 箐嚯铖 镳邃铗怵囹栩, 蝾沅 赅 陷 脲汴铋 耱屣屙 桁咫 戾耱 腓 溻篚 镟鲨屙蝾 IIa 沭箫稃, 龛 Ia 镱溷痼镲, 龛 觐眚痤朦眍 沭箫镥 耠篦噱 陷 礤 猁腩.

亦犭桷 3. 羊痼牝箴 铖腩骓屙栝 蝈麇龛 桉躅漕 徨疱戾眄铖蝈 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃.
项赅玎蝈朦 橡铖镥牝桠磬 沭箫镟 暑眚痤朦磬 沭箫镟 (n=50)
项溷痼镲 Ia (n=35) 项溷痼镲 IIa (n=31) 埋邈 (n=66)
袜痼龛 爨蝾黜瞽镫圉屙蜞痦钽 牮钼铗铌 IA 1 (2,9%) 4 (13%) 5 (7,6%) 1 (2%)
亚滦 2 (5,7%) 5 (16,1%) 7 (10,6%) 2 (4%)
缅耱铉, n (%) 1 (2,9%) 6 (16,1%) 7 (10,6%) 5 (10%)
- 脲汴铋 耱屣屙 驽耱 1 (2,9%) 4 (13%) 5 (7,6%) 5 (10%)
- 耩邃礤 耱屣屙 驽耱 0 2 (6,5%) 2 (3%) 0
0 2 (6,5%) 2 (3%) 0
- 脲汴铋 耱屣屙 驽耱 0 2 (6,5%) 2 (3%) 0
- 耩邃礤 耱屣屙 驽耱 0 0 0 0
- 驽腩 耱屣屙 耱屣屙 0 0 0 0
鱼痤玎 镳屦囗 徨疱戾眄铖蜩, n (%) 1 (2,9%) 5 (16,1%) 6 (9,1%) 5 (10%)
念耩铟眍 痤漕疣琊屮屙桢, n (%) 0 2 (6,5%) 2 (3%) 0
叔襦疱忸 皴麇龛, n (%) 35 (100%) 31 (100%) 66 (100%) 12 (24%)
蓐耱疱眄铄 赍襦疱忸 皴麇龛 疋玷 牮栩梓羼觇 耦耱龛屐 爨蝈痂/镫钿, n (%) 0 0 0 0


亦觇 钺疣珙, 麒耠 嚓篪屦耜桴 铖腩骓屙栝 珥圜栩咫 恹 镱溷痼镲 镟鲨屙蝾, 磬犭屙桢 觐蝾瘥 磬鬣腩顸 箧 镥痂钿 徨疱戾眄铖蜩, 礤 翦痱桦钽 鲨觌 (赅 镱溷痼镲 Ia).

埋 镟鲨屙蜿 猁腓 疣琊屮屙 矬蝈 铒屦圉梃 赍襦疱忄 皴麇龛. 觐眚痤朦眍 沭箫镥 腓 12 (24%) 猁腓 疣琊屮屙 矬蝈 铒屦圉梃 赍襦疱忄 皴麇龛, 犷朦眈蜮 疋铄 镫囗钼铎 镱潢: 桤-玎 磬腓麒 扈铒梃 恹耦觐 耱屣屙, 痼狯 磬 爨蜿 镱耠 铒屦圉梃 赍襦疱忄 皴麇龛, 蜞珙忸泐 镳邃脲驵龛 镫钿.

蓄滂腩顸 66 骅恹 溴蝈, 耩邃 爨耨 觐蝾瘥 耦耱噔桦 3250250 , 痤耱 512 耢, 铞屙赅 镱 嚯 里汔: 75% 8-9 徉腚钼 25% 7-8 徉腚钼. 朽眄栝 礤铐囹嚯 镥痂钿 镳铛钿桦 徨 铖钺屙眍耱彘.

昨 赅襦弪 溧朦礤轼邈 磬犭屙 蝈疣镨 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃: 玎 耋蜿 漕 铒屦圉梃 镳屣囵囹 吞 铗戾腓顸, 忸珙犴钼腓 蝈疣镨 麇疱 8 镱耠 铒屦圉梃. 橡梓屐 漕琨 吞 忄瘘桊钼嚯 玎忤耔祛耱 铗 磬腓麒 蝠铎犷蜩麇耜钽 囗囔礤玎 镟鲨屙蝾: 镳 铗泐眄铎 囗囔礤珏 镟鲨屙蜿 镱塍鬣腓 镳屣囵囹 漕珏 0,6-0,9 祀, 镳 礤铗泐眄铎 0,3 祀. 族疱 戾 铖簌羼蜮腭 镥疱躅 磬 忄痿囵桧, 镳钿铍骅蝈朦眍耱 蝈疣镨 耦耱噔豚 6 戾. (鲥脲恹 镱赅玎蝈腓 掏 2,0-3,0).

埋 镟鲨屙蜿 磬犭嚯桉 疣眄屐 镱玟礤 镱耠屦钿钼铎 镥痂钿, 镳钼钿桦 囗嚯桤 觌桧梓羼觇 耔祜蝾祛 觐眚痤朦 祛脲牦痦 爨痍屦钼 蝠铎犷翳腓. 8-10- 耋. 镱耠 铒屦圉梃 珥圜屙 镱耠邃龛 耥桄嚯桉, 蜞 驽 赅 镱赅玎蝈腓 忭篁痂耦耋滂耱钽 疋屦螓忄龛. 茵铎犷沐祛痧嚆梓羼觇 铖腩骓屙栝 (镱耠屦钿钼钽 牮钼铗鬻屙, 沐爨蝾戾蝠, 耋徼礅铍梃 爨蜿) 礤 恹怆屙 龛 钿眍 桤 镟鲨屙蝾, 礤 猁腩 恹怆屙 疣珥桷 钺戾 牮钼铒铗屦 戾驿 镟鲨屙蜿囔 镳铖镥牝桠眍 觐眚痤朦眍 沭箫, 蜞 驽 赅 礤钺躅滂祛耱 沐祛蝠囗耵箸梃, 黩 泐忸痂 徨珙镟耥铖蜩 镳桁屙屙 吞 忸 怵屐 徨疱戾眄铖蜩 镱耠屦钿钼铎 镥痂钿.

如 镳桠邃屙睇 恹 溧眄 (耢. 蜞犭. 4) 耱囗钼栩 铟邂桎睇, 黩 疣眄邋 磬鬣腩 蝈疣镨 吞 镟鲨屙蝾 镳铖镥牝桠眍 沭箫稃 镱玮铍桦 漕耱桡眢螯 镥痂磬蜞朦睇 桉躅漕 耱囹桉蜩麇耜 耩噔龛禧 蜞觐恹扈 觐眚痤朦眍 沭箫镥. 怦艴 镟鲨屙蝾 桁咫 戾耱 礤铖腩骓屙眍 蝈麇龛 徨疱戾眄铖蜩 犭嚆铒痂蝽 镥痂磬蜞朦睇 桉躅潲. 亦觇 钺疣珙, 祛骓 玎觌栩, 黩 潆 铒蜩扈玎鲨 忮溴龛 耠邃簋 徨疱戾眄铖蜩 忸珈铈眍耱 疋铄怵屐屙眍泐 磬鬣豚 噤尻忄蝽铋 镳铘桦嚓蜩麇耜铋 蝈疣镨 怦屐 镟鲨屙蜿囔 陷 囗囔礤珏 礤钺躅滂祛 镳钼钿栩 桉耠邃钼囗桢 耔耱屐 沐祛耱噻 磬 磬腓麒 沐礤蜩麇耜桴 镳桀狃弪屙睇 纛痨 蝠铎犷翳腓.

亦犭桷 4. 襄痂磬蜞朦睇 桉躅潲 镟鲨屙蝾 镳铖镥牝桠眍 觐眚痤朦眍 沭箫 (盐 耱囗溧痱眍 铗觌铐屙桢).
项赅玎蝈朦 橡铖镥牝桠磬 沭箫镟 暑眚痤朦磬 沭箫镟 (n=50)
项溷痼镲 Ia, n=35 项溷痼镲 IIa, n=31 埋邈, n=66
理蝈磬蜞朦磬 汨徨朦 镫钿, n (%) 0 0 0 0
蓄驿屙桢 骅忸泐 疱徨黻, n, (%) 35 (100%) 31 (100%) 66 (100%) 50 (100%)
锑耨 镳 痤驿屙梃 (), 耩邃礤 盐 3250(250) 3250(250) 3250(250) 3350(505,5)
8-9 徉腚钼 29 (83%) 20 (65,5%) 49(75%) 38 (76%)
7-8 徉腚钼 6 (17%) 11 (34,5%) 17(25%) 12 (24%)
6 戾礤 徉腚钼 0 0 0 0
湾钺躅滂祛耱 镥疱忸溴 耧弼栲腓玷痤忄眄 耱圉桀磬 潆 恹踵骅忄龛 眍忸痤驿屙睇, n(%) 0 0 0 0


蔓忸潲

1. 埋艴 镟鲨屙蝾 陷 囗囔礤珏 礤钺躅滂祛 钺耠邃钼囹 磬 磬腓麒 蝠铎犷翳腓 (镳桀狃弪屙眍 沐礤蜩麇耜铋).

2. 蔓怆屙桢 蝠铎犷翳腓 (镳桀狃弪屙眍, 沐礤蜩麇耜铋 桦 耦麇蜞眄铋) 镟鲨屙蝾 陷 囗囔礤珏 溧弪 忸珈铈眍耱 镟蝾沐礤蜩麇耜 钺铖眍忄螯 翦牝桠眢 镳铘桦嚓蜩牦 钽 铖腩骓屙 镳 镱耠邃簋 徨疱戾眄铖蜩.

3. 碾 镳邃铗怵帙屙 镱怛铕眍 陷 镳 镱耠邃簋 徨疱戾眄铖蜩 礤钺躅滂祛 磬麒磬螯 蝈疣镨 翦痱桦钽 鲨觌, 镳钿铍驵 忸 怵屐 徨疱戾眄铖蜩, 痤漕 镱耠屦钿钼铎 镥痂钿. 义疣镨 漕腈磬 怅膻鬣螯 吞, 忤蜞扈睇 沭箫稃 , 囗蜩铌耔溧眚 扈牮铐桤桊钼囗睇 镳钽羼蝈痤.

4. 悟戾磬 吞 玎 24 漕 镫囗桊箦祛 铒屦圉梃 赍襦疱忸 皴麇龛 忸珙犴钼脲龛 邈 镳桁屙屙 麇疱 8 镱耠 铒屦圉梃 镱玮铍桦 100% 耠篦噱 桤徨驵螯 沐祛痧嚆梓羼觇 蝠铎犷蜩麇耜桴 铖腩骓屙栝.


髓蝈疣蝮疣:

1. 拎殪箴噤钼 .. 相蝾沐礤, 镳桧鲨稃 滂嚆眍耱桕, 镳铘桦嚓蜩觇 蝈疣镨 耔礓痤爨 镱蝈痂 镫钿, 钺篑腩怆屙眍泐 镳桀狃弪屙睇扈 沐礤蜩麇耜桁 溴翦牝囔 沐祛耱噻. 蔫. ... 漕牝. 戾. 磬箨. . 2007; 396 .
2. 凌鲟溏 .. 相蝾沐礤, 镳桧鲨稃 滂嚆眍耱桕 镳铘桦嚓蜩觇 铖腩骓屙栝 徨疱戾眄铖蜩, 钺篑腩怆屙睇 蝠铎犷翳腓彘. 蔫. ... 漕牝. 戾. 磬箨. . 2004; 251 .
3. 锑赅鲟痂 .., 凌鲟溏 .., 狸桧桧 .. 茵铎犷 蝠铎犷犷腓 嚓篪屦耜瞽汨礤觐腩汨麇耜铋 镳嚓蜩赍. 2007; 151 .
4. 锑赅鲟痂 .., 凌鲟溏 .., 鸯桊眍忄 .., 狸桧桧 .., 拎殪箴噤钼 .. 茵铎犷沐祛痧嚆梓羼觇 铖腩骓屙 嚓篪屦耜瞽汨礤觐腩汨麇耜铋 镳嚓蜩赍. 畜觐忸漶蜮 潆 怵圜彘. . 2011; 1056 .
5. Alfirevic Z., Roberts D. et al. How strong is the association between maternal thrombophilia and adverse pregnancy outcomes. A systematic review. Eur. J. Obstet. Gyn. Reprod. Biol. 2002; 101 (1): 6-14.
6. Brenner B., Hoffman R., Blumenfeld Z. et al. Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin. Thromb. Haemost. 2000 May; 83 (5): 693-7.
7. Cervera R., Piette J.C., Font J. et al. Euro-Phospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifes-tations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002. Apr; 46 (4): 1019-27.55.
8. Dossenbach-Glaninger A., van Trotsenburg M., Dossenbach M. et al. Plasminogen activator inhibitor 1 4G/5G polymorphism and coagulation factor XIII Val34Leu polymorphism: impaired fibrinolysis and early pregnancy loss. Clin. Chem. 2003 Jul; 49 (7): 1081-6.
9. Gris J.C., Mercier E., Qu閞 I. et al. Low-molecular-weight heparin versus lowdose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood. 2004 May 15; 103 (10): 3695-9.
10. Kovac M., Mitic G. et al. Thrombophilia in women with pregnancy-associated complications: fetal loss and pregnancy-related venous thromboembolism. Gynecol. Obstet. Invest. 2010; 69 (4): 233-8.
11. Kupferminc M.J. Thrombophilia and pregnancy. Reprod. Biol. Endocrinol. 2003; 1: 111.
12. Lyall Fiona, Belfort Michael, editors. Preeclampsia. Etiology and clinical practice. Cambridge, UK. 2007.
13. Main E.K. Maternal mortality: new strategies for measurement and prevention. Curr. Opin. Obstet. Gynecol. 2010 Dec; 22 (6): 511-6.
14. National Institute for Clinical Excellence. Why Women die. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom, 1997-1999. London. 2001.
15. Pandey M., Mantel G.D., Moodley J. Audit of severe acute morbidity in hypertensive pregnancies in a developing country. J. Obstet. Gynecol. 2004; 24: 387-391.
16. Saving Mothers. Third Report on Confidential Enquiries into Maternal Deaths in South Africa 2002-2004. Department of Health, Pretoria.
17. Villar J., Abalos E., Nardin J.M., Merialdi M., Carroli G. Strategies to prevent and treat preeclampsia: evidence from randomized controlled trials. Semin. Nephrol. 2004; 24 (6): 607-15.


References:

1. Baimuradova S.M. Patogenez, printsipy diagnostiki, profilaktiki i terapii sindroma poteri ploda, obuslovlennogo priobretennymi i geneticheskimi defektami gemostaza. Dis. ... dokt. med. nauk. Doct, Diss. (Pathogenesis, principles of diagnosis, prevention and treatment of the syndrome of fetal loss due to genetic defects and acquired hemostasis). Dr. diss. Moscow. 2007; 396 s.
2. Bitsadze V.O. Patogenez, printsipy diagnostiki i profilaktiki oslozhnenii beremennosti, obuslovlennykh trombofiliei. Dis. ... dokt. med. nauk. Doct, Diss. (Pathogenesis, principles of diagnosis and prevention of complications of pregnancy, due to thrombophilia). Dr. diss. Moscow. 2004; 251 s.
3. Makatsariya A.D., Bitsadze V.O., Akin抯hina S.V. Thrombosis and thromboembolism in obstetric practice [Tromboz i tromboembolii v akushersko-ginekologicheskoi praktike]. 2007; 151 s.
4. Makatsariya A.D., Bitsadze V.O., Smirnova L.M., Akin抯hina S.V., Baimuradova S.M. Thrombohemorrhagic complications in obstetric practice. Guidance for doctors [Trombogemorragicheskie oslozhneniya v akushersko-ginekologicheskoi praktike. Rukovodstvo dlya vrachei]. Moscow. 2011; 1056 s.
5. Alfirevic Z., Roberts D. et al. How strong is the association between maternal thrombophilia and adverse pregnancy outcomes. A systematic review. Eur. J. Obstet. Gyn. Reprod. Biol. 2002; 101 (1): 6-14.
6. Brenner B., Hoffman R., Blumenfeld Z. et al. Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin. Thromb. Haemost. 2000 May; 83 (5): 693-7.
7. Cervera R., Piette J.C., Font J. et al. Euro-Phospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifes-tations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002. Apr; 46 (4): 1019-27.55.
8. Dossenbach-Glaninger A., van Trotsenburg M., Dossenbach M. et al. Plasminogen activator inhibitor 1 4G/5G polymorphism and coagulation factor XIII Val34Leu polymorphism: impaired fibrinolysis and early pregnancy loss. Clin. Chem. 2003 Jul; 49 (7): 1081-6.
9. Gris J.C., Mercier E., Quéré I. et al. Low-molecular-weight heparin versus lowdose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood. 2004 May 15; 103 (10): 3695-9.
10. Kovac M., Mitic G. et al. Thrombophilia in women with pregnancy-associated complications: fetal loss and pregnancy-related venous thromboembolism. Gynecol. Obstet. Invest. 2010; 69 (4): 233-8.
11. Kupferminc M.J. Thrombophilia and pregnancy. Reprod. Biol. Endocrinol. 2003; 1: 111.
12. Lyall Fiona, Belfort Michael, editors. Preeclampsia. Etiology and clinical practice. Cambridge, UK. 2007.
13. Main E.K. Maternal mortality: new strategies for measurement and prevention. Curr. Opin. Obstet. Gynecol. 2010 Dec; 22 (6): 511-6.
14. National Institute for Clinical Excellence. Why Women die. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom, 1997-1999. London. 2001.
15. Pandey M., Mantel G.D., Moodley J. Audit of severe acute morbidity in hypertensive pregnancies in a developing country. J. Obstet. Gynecol. 2004; 24: 387-391.
16. Saving Mothers. Third Report on Confidential Enquiries into Maternal Deaths in South Africa 2002-2004. Department of Health, Pretoria.
17. Villar J., Abalos E., Nardin J.M., Merialdi M., Carroli G. Strategies to prevent and treat preeclampsia: evidence from randomized controlled trials. Semin. Nephrol. 2004; 24 (6): 607-15.



Antithrombotic prophylaxis repeated preeclampsia in patients with thrombophilia

Zhuravleva E.V.


First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation

Abstract. Objective. To evaluate the efficiency of antithrombotic therapy to prevent repeated preeclampsia in patients with thrombophilia. Subject and methods. A prospective clinical study was conducted 66 patients with thrombophilia (genetic, acquired or concomitant) and with history of preeclampsia: 35 patients addressed and were followed since fertile cycle (subgroup Ia) and 31 patients addressed during pregnancy and were followed since 6-13 weeks of gestation IIa subgroup. Control group 50 patients without both obstetrics and gynecology and thrombotic complications in history. Therapy included LMWG (klexan), B vitamins, antioxidants and micronized progesterone. Results. The all period of pregnancy, obstetric and perinatal outcomes were better in patients receiving therapy since fertile cycle compared with group of patients whose therapy was initiated during pregnancy.Conclusion. To prevent re-PE at a subsequent pregnancy, the therapy should be start since fertile cycle, continuing during pregnancy, childbirth and the postpartum period. Therapy should include LMWH, B vitamins, antioxidants and micronized progesterone.

Key words: preeclampsia, antithrombotic therapy, LMWG, thrombophilia.