Gefässchirurgie

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

Diagnostik und Therapie der Rezidivthrombose

Leitthema
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Zusammenfassung

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.

Schlüsselworte

D-Dimer Niedermolekulares Heparin Phlebographie Rezidivthrombose Rezidivrisiko Sekundärprophylaxe Sonographie Thrombose 

Diagnosis and therapy of recurrent thrombosis

Abstract

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.

Keywords

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

Literatur

  1. 1.
    Baglin T, Luddington R, Browen K, Baglin C (2003) Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 362: 523–526CrossRefPubMedGoogle Scholar
  2. 2.
    Brouwer JL, Veeger NJ, Ten Cate MK et al. (2005) Hereditary deficiencies of protein C, protein S and antithrombin protect against bleeding during anticoagulant treatment. Results from a family cohort study. Abstract P1857 ISTH 2005 Sydney. J Thromb Haemost 3 (Suppl 1)Google Scholar
  3. 3.
    Büller HR, Agnelli G, Hull RD et al. (2004) Antithrombotic therapy for venous thromboembolic disease. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 401S-28SCrossRefPubMedGoogle Scholar
  4. 4.
    Büller HR, Sohne M, Middeldorp S (2005) Treatment of venous thromboembolism. J Thromb Haemost 3: 1554–1560CrossRefPubMedGoogle Scholar
  5. 5.
    Cosmi B, Legnani C, Cini M, Guazzaloca G, Palareti G (2005) D-dimer and factor VIII are independent risk factors for recurrence after anticoagulation withdrawal for a first idiopathic deep vein thrombosis. Abstract OR180 ISTH 2005 Sydney. J Thromb Haemost 3 (Suppl 1)Google Scholar
  6. 6.
    Cushman M, Folsom AR, Wang L, Aleksic N et al. (2003) Fibrin fragment D-dimer and the risk of future venous thrombosis. Blood 101: 1243–1248CrossRefPubMedGoogle Scholar
  7. 7.
    Daskalopoulos ME, Daskalopoulou SS, Tzortzis E et al. (2005) Long-term treatment of deep venous thrombosis with a low molecular weight heparin (tinzaparin): a prospective randomized trial. Eur J Vasc Endovasc Surg 29: 638–650CrossRefPubMedGoogle Scholar
  8. 8.
    Fattorini A, Crippa L, Vigano’D’Angelo S, Pattarini E, D’Angelo A (2002) Risk of deep vein thrombosis recurrence: high negative predicted value of D-dimer performed during oral anticoagulation. Thromb Haemost Jul 88(1): 162–163Google Scholar
  9. 9.
    Gomez-Outes A, Lecumberri R, Lafuente-Guijosa A et al. (2004) Correlation between thrombus regression and recurrent venous thromboembolism. Examining venographic and clinical effects of low- molecular-weight heparins: a meta-analysis. J Thromb Haemost 2: 1581–1587CrossRefPubMedGoogle Scholar
  10. 10.
    van der Heijden JF, Hutten BA, Buller HR, Prins MH (2004) Vitamin K antagonists or low-molecular weight heparin for venous thromboembolism. The Cochrane Database of Systematic Reviews, Cochrane Library no: CD002001. In: The Cochrane Library [database online]. Issue 2. Oxford: Update SoftwareGoogle Scholar
  11. 11.
    Hron G, Eichinger S, Weltermann A et al. (2005) A positive family history of venous thromboembolism does not predict a high risk of recurrence. Abstract P0438 ISTH 2005 Sydney. J Thromb Haemost 3 (Suppl 1)Google Scholar
  12. 12.
    Kearon C, Ginsberg JS, Kovacs MJ et al. (2003) Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy of recurrent venous thromboembolism. N Engl J Med 349: 631–639CrossRefPubMedGoogle Scholar
  13. 13.
    Linkins LA, Choi PT, Douketis JD (2003) Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism : a meta-analysis. Ann Intern Med 139: 893–900PubMedGoogle Scholar
  14. 14.
    Palareti G, Legnani C, Cosmi B et al. (2003) Predictive value of D-dimer test for recurrent venous thromboembolism after anticoagulation withdrawal in subjects with a previous idiopathic event and in carriers of congenital thrombophilia. Circulation 108: 313–318CrossRefPubMedGoogle Scholar
  15. 15.
    Palareti G, Legnani C, Cosmi B, Guazzaloca G, Cini M, Mattarozzi S (2005) Extremely poor quality of oral anticoagulation control during the first three months after unprovoked venous thromboembolism is a risk factor for long term recurrence and is associated with higher D-dimer levels. Abstract OR179 ISTH 2005 Sydney. J Thromb Haemost 3 (Suppl 1)Google Scholar
  16. 16.
    Prandoni P, Lensing AW, Piccioli A et al. (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100: 3484–3488CrossRefPubMedGoogle Scholar
  17. 17.
    Prandoni P, Lensing AW, Prins MH, Bernardi E et al. (2002) Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med 137: 955–960PubMedGoogle Scholar
  18. 18.
    Prandoni P, Ghirarduzzi A, Pengo V, Noventa F, Bernardi E (2005) The risk of recurrent venous thromboembolism after stopping anticoagulation in patients with acute deep vein thrombosis or pulmonary embolism. A multicenter cohort study in 1611 patients. Abstract P1647 ISTH 2005 Sydney. J Thromb Haemost: 3 (Suppl 1)Google Scholar
  19. 19.
    Ridker PM, Goldhaber SZ, Danielson E et al. (2003) Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 348: 1425–1434CrossRefPubMedGoogle Scholar
  20. 20.
    Schonauer V, Kyrle PA, Weltermann A et al. (2003) Superficial thrombophlebitis and risk for recurrent venous thromboembolism. J Vasc Surg 37: 834–838CrossRefPubMedGoogle Scholar
  21. 21.
    Siragusa S, Malato A, Anastasio R et al. (2005) Residual vein thrombosis assessment establishes the optimal duration of oral anticoagulants in patients with idiopathic or provoked deep vein thrombosis: a randomised, controlled trial. Abstract OR176 ISTH 2005 Sydney. J Thromb Haemost 3 (Suppl 1)Google Scholar
  22. 22.
    Young L, Ockelford PA, Milne D et al. (2005) Post treatment residual thrombus is associated with an increased risk of DVT recurrence, mortality and a trend towards increased vascular death. Abstract OR365 ISTH 2005 Sydney. J Thromb Haemost 3 (Suppl 1)Google Scholar

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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