, Volume 11, Issue 1, pp 28–32 | Cite as

Diagnostik und Therapie der Rezidivthrombose



Weitgehend unabhängig von der Dauer der Antikoagulation erleiden bis zu 30% der Patienten mit einer TVT ein Rezidiv innerhalb von 2 Jahren nach Beendigung der Antikoagulation. Die Diagnose einer Rezidivthrombose gestaltet sich in aller Regel schwieriger als die Diagnose einer Erstthrombose, weil die Möglichkeiten der sonographischen Diagnostik bei gleicher Lokalisation des Thrombus begrenzt sind. Die Diagnostik wird durch eine genaue morphologische Dokumentation des Zustands am Ende der Sekundärprophylaxe der Erstthrombose erleichtert. Gute Hilfe leistet auch der D-Dimer-Test, wenn er nach der Erstthrombose wieder normalisiert war. Ohne morphologisch gesicherte Diagnose oder gar bei normalen D-Dimer-Werten ist eine Wiederaufnahme der Antikoagulation nicht indiziert. Bei nachgewiesener TVT ist die Behandlung grundsätzlich gleich wie bei der Erstthrombose. Die Dauer der Sekundärprävention sollte von der Ursache und möglichen Begleitumständen abhängig gemacht werden. Keinesfalls bedeutet die Rezidivthrombose automatisch die Indikation zur lebenslangen Antikoagulation.


D-Dimer Niedermolekulares Heparin Phlebographie Rezidivthrombose Rezidivrisiko Sekundärprophylaxe Sonographie Thrombose 

Diagnosis and therapy of recurrent thrombosis


The recurrence rate of deep vein thrombosis (DVT) may be as high as 30% in patients with a first idiopathic episode, independent of the duration of anticoagulant treatment. Diagnosis of recurrence in the same leg is hampered because the differentiation between new and old thrombi is difficult using ultrasound. It is, however, rather straightforward if the venous pathology at the time of cessation of anticoagulant treatment has been documented in detail. An ultrasound examination is therefore recommended before stopping secondary prophylaxis. Assessment of the D-dimer concentration in blood emerges as a useful tool, as normal values are a strong argument against DVT recurrence. Anticoagulant therapy should not be resumed without morphologic evidence of new DVT and when levels of D-dimer are not elevated. Proven recurrent DVT might call for an intensified search for the cause. Treatment of recurrent DVT is the same as that for the first episode. Its duration should be tailored individually. A second DVT should not automatically lead to life-long anticoagulant therapy.


D-Dimer Low molecular weight heparin Phlebography Compression ultrasound DVT Recurrence of deep vein thrombosis Secondary prevention 


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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Facharzt für Gefäßmedizin FMHAngio Bellaria, Zentrum für GefäßkrankheitenZürich
  2. 2.Phlebologische PraxisMannheim
  3. 3.Facharzt für Gefäßmedizin FMHAngio Bellaria, Zentrum für GefäßkrankheitenZürich

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