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Venöse Thromboembolieprophylaxe

Venous thromboembolism prophylaxis

Der Anaesthesist volume 53, pages 657–674 (2004)Cite this article

Zusammenfassung

Eine tiefe Venenthrombose (TVT) ist eine typische Komplikation von hospitalisierten Patienten. Einige venöse Thrombosen bleiben subklinisch, andere jedoch imponieren durch eine symptomatische tiefe Beinvenenthrombose oder durch eine Lungenembolie (LE). Durch ihre hohe Inzidenz sind die TVT und die LE wichtige Ursachen für die Letalität und Morbidität während eines Krankenhausaufenthaltes. Das Risiko, eine Thromboembolie (TE) zu erleiden, wird durch dispositionelle und expositionelle Risikofaktoren erhöht. Entsprechend der Disposition wird eine risikoadaptierte Thromboembolieprophylaxe durchgeführt. Für die Thromboembolieprophylaxe stehen sowohl medikamentöse als auch physikalische Optionen zur Verfügung.

Abstract

Venous thromboembolism is a common and frequent complication of hospitalized patients. Some venous thromboembolisms may be subclinical, while others present as symptomatic deep vein thrombosis and/or pulmonary embolism. Venous thromboembolism and pulmonary embolism contribute significantly to inhospital morbidity and mortality. The risk of venous thromboembolism is aggravated by dispositional and/or expositional risk factors. In patients at intermediate or high risk of venous thromboembolism, additional pharmacological thromboembolism prophylaxis becomes mandatory.

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Notes

  1. Diagnostik und Score-System zur Wahrscheinlichkeit des Vorhandenseins einer TVT nach Wells : s. http://awmf.org Leitlinien der Deutschen Gesellschaft für Phlebologie.

Literatur

  1. ACCP-HLBI National Conference on Antithombotic Therapy (1986) Chest 114:439S–769S

    Google Scholar 

  2. Agnelli G, Piovella F, Buoncristiani P et al. (1998) Enoxaparin plus compression stockings compared with compression stockings alone. N Engl J Med 339:80–85

    CAS  PubMed  Google Scholar 

  3. Agu O, Hamilton G, Baker D (1999) Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg 86:992–1004

    Article  CAS  PubMed  Google Scholar 

  4. Amarigiri SV, Lees TA (2000) Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev CD001484

  5. Attia J, Ray JG, Cook DJ et al. (2001) Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med 161:1268–1279

    CAS  PubMed  Google Scholar 

  6. Bauer KA, Eriksson BI, Lassen MR, Turpie AG (2001) Steering Committee of the Pentasaccharide in Major Knee Surgery Study. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery. N Engl J Med 345:1305–1310

    Article  CAS  PubMed  Google Scholar 

  7. Benko T, Cooke EA, McNally MA, Mollan RA (2001) Graduated compression stockings: knee length or thigh length. Clin Orthop 383:197–203

    PubMed  Google Scholar 

  8. Byrne B (2001) Deep vein thrombosis prophylaxis: the effectiveness and implications of using below-knee or thigh-length graduated compression stockings. Heart Lung 30:277–284

    Article  CAS  PubMed  Google Scholar 

  9. Chylarecki CF, Hierholzer G, Rudofsky G (1995) Physikalische Thromboseprophylaxe mit motorisierter Sprunggelenkbewegungsschiene. Unfallchirurgie 21:137–147

    CAS  PubMed  Google Scholar 

  10. Dahl OE, Andreassen G, Aspelin T et al. (1997) Prolonged thromboprophylaxis following hip replacement surgery-results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin. Thromb Haemost 77:26–31

    CAS  PubMed  Google Scholar 

  11. Diuguid D (2001) Choosing a parenteral anticoagulant agent. N Engl J Med 345:1340–1341

    Article  CAS  PubMed  Google Scholar 

  12. Eriksson BI, Ekman S, Kalebo P et al. (1996) Prevention of deep-vein thrombosis after total hip replacement: direct thrombin inhibition with recombinant hirudin, CGP 39393. Lancet 347:635–639

    Article  CAS  PubMed  Google Scholar 

  13. Eriksson BI, Wille-Jorgensen P, Kalebo P et al. (1997) A comparison of recombinant hirudin with a low-molecular-weight heparin to prevent thromboembolic complications after total hip replacement. N Engl J Med 337:1329–1335

    Article  CAS  PubMed  Google Scholar 

  14. Eriksson BI, Bergqvist D, Kalebo P et al. (2002) Ximelagatran and melagatran compared with dalteparin for prevention of venous thromboembolism after total hip or knee replacement: the METHRO II randomised trial. Lancet 360:1441–1447

    Article  CAS  PubMed  Google Scholar 

  15. Eriksson BI, Agnelli G, Cohen AT et al. (2003) The direct thrombin inhibitor melagatran followed by oral ximelagatran compared with enoxaparin for the prevention of venous thromboembolism after total hip or knee replacement: the EXPRESS study. J Thromb Haemost 1:2490–2496

    CAS  PubMed  Google Scholar 

  16. Eriksson BI, Bauer KA, Lassen MR, Turpie AG (2001) Steering Committee of the Pentasaccharide in Hip-Fracture Surgery Study. Fondaparinux compared with enoxaparin for the prevention of venou thromboembolism after hip-fracture surgery. N Engl J Med 345:1298–1304

    Article  CAS  PubMed  Google Scholar 

  17. Fifth ACCP Consensus Conference on Antithrombotic Therapy (1998) Chest 114. Supplementum

  18. Geerts WH, Jay RM, Code KI et al. (1996 )A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med. 335:701–707

    Google Scholar 

  19. Gogarten W, Van Aken H, Büttner J et al. (2003) Rückenmarksnahe Regionalanästhesien und Thrombembolieprophylaxe/antithrombotische Medikation. Anaesth Intensivmed 44:218–230

    Google Scholar 

  20. Haas S (1997) Thrombose in der Unfall- und Orthopädischen Chirurgie. Unfallchirurg 100:307–319

    CAS  PubMed  Google Scholar 

  21. Hameed MF, Browse DJ, Immelman EJ, Goldberg PA (2002) Should knee-length replace thigh-length graduated compression stockings in the prevention of deep-vein thrombosis? S Afr J Surg. 40:15–16

    Google Scholar 

  22. Hirsh J, Dalen J, Guyatt G (2001) The sixth (2000) ACCP Guidelines for Antithrombotic Therapy for Prevention and Treatment of Thrombosis. Chest 119:1S–2S

    Article  CAS  PubMed  Google Scholar 

  23. Huber O, Bounameaux H, Borst F, Rohner A (1992) Postoperative pulmonary embolism after hospital discharge. An underestimated risk. Arch Surg 127:310–313

    CAS  PubMed  Google Scholar 

  24. Hunt BJ, Doughty HA, Majumdar G et al. (1997) Thromboprophylaxis with low molecular weight heparin (Fragmin) in high risk pregnancies. Thromb Haemost 77:39–43

    CAS  PubMed  Google Scholar 

  25. Lassen MR, Bauer KA, Eriksson BI et al. (2002) Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised double-blind comparison. Lancet 359:1715–1720

    Article  CAS  PubMed  Google Scholar 

  26. Mercett ND, Hanel KC (1993) Ischaemic complications of graduated compression stockings in the treatment of deep venous thrombosis. Postgrad Med J 69:232–234

    PubMed  Google Scholar 

  27. Mullges W, Steinke E, Moldenhauer G, Berens N (2001) Customary use of compression stockings for prevention of thrombosis in medical intensive care units in Germany. Dtsch Med Wochenschr 126:867–871

    Article  CAS  PubMed  Google Scholar 

  28. Nicolaides AN, Bergqvist D, Hull R (1997) Prevention of venous thromboembolism. International Consensus Statement (Guidelines according to scientific evidence). Int Angiol 16:3–38

    PubMed  Google Scholar 

  29. Nicolaides AN, Breddin HK, Fareed J et al. (2001) Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol 20:1–37

    CAS  PubMed  Google Scholar 

  30. Partsch H, Kahn P (1982) Venöse Strömungsbeschleunigung in Bein und Becken durch „Anti-Thrombose-Strümpfe“. Klinikarzt 11:609–615

    Google Scholar 

  31. Porteous MJ, Nicholson EA, Mores LT et al. (1989) Thigh length versus knee length stockings in the prevention of deep vein thrombosis. Br J Surg 76:296–297

    CAS  PubMed  Google Scholar 

  32. Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95:2s–4s

    CAS  PubMed  Google Scholar 

  33. Samama MM, Cohen AT, Darmon JY et al. (1999) A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 341:793–800

    Article  CAS  PubMed  Google Scholar 

  34. Stationäre und ambulante Thromboembolieprophylaxe in der Chirurgie und der perioperativen Medizin (2003) Anaesth Intensivmed 44:582–588

    Google Scholar 

  35. Turpie AG, Bauer KA, Eriksson BI et al. (2002) Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism after elective hip-replacement surgery: a randomised double-blind trial. Lancet 359:1721–1726

    Article  CAS  PubMed  Google Scholar 

  36. Turpie AG, Gallus AS, Hoek JA, Pentasaccharide Investigators (2001) A synthetic pentasaccharide for the prevention of deep-vein thrombosis after total hip replacement. N Engl J Med 344:619–625

    Article  CAS  PubMed  Google Scholar 

  37. Wulf H (1995) Thrombembolieprophylaxe und rückenmarksnahe Regionalanästhesie. Anaesth Intensivmed 36:216–217

    Google Scholar 

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Affiliations

  1. Klinik für Anästhesiologie, Aachen

    B. Dohmen, R. Kuhlen & R. Rossaint

  2. Klinik und Polyklinik für Anästhesiologie und operative Intensivmedizin, Münster

    W. Gogarten

  3. Klinik für Anästhesiologie, Universität Aachen, Pauwelsstraße 30, 52074 , Aachen

    B. Dohmen

Authors
  1. B. Dohmen
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  2. W. Gogarten
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  3. R. Kuhlen
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  4. R. Rossaint
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Correspondence to B. Dohmen.

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Dohmen, B., Gogarten, W., Kuhlen, R. et al. Venöse Thromboembolieprophylaxe. Anaesthesist 53, 657–674 (2004). https://doi.org/10.1007/s00101-004-0696-y

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  • DOI: https://doi.org/10.1007/s00101-004-0696-y

Schlüsselwörter

  • Venöse Thromboembolie
  • Lungenembolie
  • Dispositionelle Risikofaktoren
  • Expositionelle Risikofaktoren
  • Risikoadaptierte Thromboembolieprophylaxe

Keywords

  • Venous thromboembolism
  • Pulmonary embolism
  • Dispositional risk factors
  • Expositional risk factors
  • Thromboembolism prophylaxis