Der Anaesthesist

, Volume 57, Issue 4, pp 374–381 | Cite as

Gerinnungsmanagement bei Eingriffen mit extrakorporaler Zirkulation

Klinischer Therapiealgorithmus
  • C. Jámbor
  • D. Bremerich
  • A. Moritz
  • E. Seifried
  • B. Zwissler
Allgemeinanästhesie

Zusammenfassung

Nach kardiochirurgischen Eingriffen mit extrakorporaler Zirkulation (EKZ) wird bei 20% der Patienten eine klinisch relevante Blutungsneigung beobachtet; 5% der Patienten werden rethorakotomiert. Die Identifikation einer chirurgischen Blutungsquelle erfolgt nur bei der Hälfte dieser Patienten; dies deutet auf eine Koagulopathie nach der EKZ hin. Für das perioperative Management dieser Koagulopathie entwickelten die Autoren einen klinischen Algorithmus, um die Transfusion von Plasmaprodukten und Gerinnungsfaktoren zu steuern. Dieser vorgestellte Algorithmus basiert auf der heute verfügbaren Evidenz und klinischer Erfahrung. Als diagnostische Möglichkeiten werden „Point-of-care“-Bestimmungen [Blutgasanalyse, „activated clotting time“ (ACT), Quick-Wert, aktivierte partielle Thromboplastinzeit (aPTT) und Thrombozytenzahl] verwendet. Es wird die Intervention mit Plasmaprodukten, Gerinnungsfaktoren und hämostatisch wirksamen Medikamenten nach EKZ beschrieben. Die detaillierte Blutungsanamnese sowie Wirksamkeit und Nebenwirkungsprofil von Antifibrinolytika für eine differenzierte Indikationsstellung werden diskutiert.

Schlüsselwörter

Gerinnungsmanagement Koagulopathie Extrakorporale Zirkulation Kardiochirurgie Antifibrinolytika 

Management of hemostasis disorders after extracorporeal circulation

A clinical therapy algorithm

Abstract

After cardiac surgery with extracorporeal circulation, approximately 20% of patients show significant bleeding tendencies and 5% require re-intervention. In 50% of patients undergoing re-operation, no surgical cause can be determined, suggesting coagulopathy after cardiopulmonary bypass (CPB). For perioperative management of transfusion of blood products and coagulation factor concentrates, a clinical algorithm for the perioperative hemostatic therapy in patients undergoing cardiac surgery with CPB has been developed. The currently available evidence and the point of care methods routinely accessible in our institution (blood gas analysis, ACT, point of care Quick value, aPTT and platelet count) were used. The intervention with plasma products, coagulation factor concentrates and hemostatic drugs after extracorporeal circulation are described. Extensive bleeding history as well as the efficacy and side effects of antifibrinolytic treatment are discussed.

Keywords

Management of coagulation disorders Coagulopathy Extracorporeal circulation Cardiac surgery Antifibrinolytics 

Notes

Interessenskonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Frau Dr. C. Jámbor hat von den Firmen CSL Behring, Novo Nordisk Pentapharm, Dynabyte und IL Honorare für wissenschaftliche Vorträge erhalten. Die Präsentation des Themas ist unabhängig und in der Darstellung der Inhalte produktneutral.

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  • C. Jámbor
    • 1
  • D. Bremerich
    • 2
  • A. Moritz
    • 3
  • E. Seifried
    • 4
  • B. Zwissler
    • 1
  1. 1.Klinik für Anästhesiologie, Intensivmedizin und SchmerztherapieKlinikum der Johann Wolfgang Goethe-Universität FrankfurtFrankfurt a.M.Deutschland
  2. 2.Abteilung für Anästhesiologie und operative IntensivmedizinSt. Vincenz-KrankenhausLimburgDeutschland
  3. 3.Klinik für Thorax-, Herz- und thorakale GefäßchirurgieKlinikum der Johann Wolfgang Goethe-UniversitätFrankfurtDeutschland
  4. 4.Institut für Transfusionsmedizin und ImmunhämatologieDRK-Blutspendedienst Baden-Württemberg – HessenFrankfurtDeutschland

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