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Akute Lungenembolie und Kontraindikation für eine Antikoagulation

Bettseitige Implantation eines neuen passageren V.-cava-inferior-Filters

Acute pulmonary embolism and contraindication of anticoagulation

Bedside implantation of a new temporary vena cava inferior filter

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Zusammenfassung

Lungenarterienembolien (LE) sind lebensgefährliche Komplikationen, häufig bedingt durch tiefe Beinvenenthrombosen bei kritisch kranken Patienten auf Intensivstationen. Bei Vorliegen von Kontraindikationen gegenüber einer Antikoagulation stellt die Implantation eines V.-cava-Filters (VCF) eine mögliche Alternative zur Prophylaxe einer LE dar. Sie kann Schutz vor aszendierenden Thromben bieten. Wir berichten über den Fall einer 56-jährigen Patientin mit intrazerebraler Blutung, die eine 2‑malige zentrale LE erlitt. Bei Kontraindikation einer aktuellen Antikoagulation erfolgte die bettseitige Implantation eines neuartigen VCF bis zur Überbrückung der Kontraindikationsphase für Antikoagulation. Bei Entfernung konnten mehrere Thromben im Nitinolgerüst des VCF nachgewiesen werden.

Abstract

Pulmonary embolism (PE), mostly caused by deep vein thrombosis, is a life-threatening complication in critically ill patients in the intensive care unit. A potential strategy to prevent PE in patients with contraindication for anticoagulant therapy is the implantation of a vena cava filter (VCF), to provide fast and safe PE protection against ascending thrombi. We report the case of a 56-year-old woman with an intracranial hemorrhage, who developed a PE. Because of acute contraindications for anticoagulant therapy, bedside implantation of a new VCF was performed to overcome the period of absolute contraindications for anticoagulation. After explanation, several thrombi were found on the filter.

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Authors and Affiliations

  1. I. Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    S. Baumann, T. Becher, C. Jabbour, C. Fastner, K. Giannakopoulos, M. Behnes, S. Britsch, D. Loßnitzer, M. Borggrefe & I. Akin

  2. Institut für Klinische Radiologie und Nuklearmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland

    T. Henzler

  3. Neurologische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland

    A. Alonso

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  1. S. Baumann
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  2. T. Becher
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  3. C. Jabbour
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  4. C. Fastner
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  5. K. Giannakopoulos
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  6. M. Behnes
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  7. T. Henzler
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  8. A. Alonso
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  9. S. Britsch
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  10. D. Loßnitzer
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  11. M. Borggrefe
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  12. I. Akin
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Corresponding author

Correspondence to S. Baumann.

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Interessenkonflikt

S. Baumann, T. Becher, C. Jabbour, C. Fastner, K. Giannakopoulos, M. Behnes, T. Henzler, A. Alonso, S. Britsch, D. Loßnitzer, M. Borggrefe und I. Akin geben an, den bettseitig implantierbaren V.-cava-Filter (Angel® Catheter) kostenfrei von der Firma BiO2 Medical, Inc. (San Antonio, TX, USA) zur Verfügung gestellt bekommen zu haben, jedoch keine Honorare oder sonstige finanzielle Zuwendungen erhalten zu haben.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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R. Riessen, Tübingen

Die Autoren S. Baumann und T. Becher haben zu gleichen Teilen zu diesem Manuskript beigetragen.

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Baumann, S., Becher, T., Jabbour, C. et al. Akute Lungenembolie und Kontraindikation für eine Antikoagulation. Med Klin Intensivmed Notfmed 112, 246–251 (2017). https://doi.org/10.1007/s00063-016-0201-9

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  • DOI: https://doi.org/10.1007/s00063-016-0201-9

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