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Fehler und Gefahren der perioperativen Lysetherapie

Errors and risks in perioperative thrombolysis therapy

  • Fehler und Gefahren
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Zusammenfassung

Eine perioperative Lysetherapie galt lange wegen des lyseinduzierten Blutungsrisikos als kontraindiziert. Mittlerweile hat sich gezeigt, dass Thrombolytika auch perioperativ erfolgreich eingesetzt werden können. Mögliche Indikationen sind die massive Lungenembolie und die kardiopulmonale Reanimation; sie stellen perioperativ wichtige Ursachen für einen Herz-/Kreislaufstillstand dar. Thrombolyse kann die entscheidende Therapieoption sein, wenn z. B. konventionelle Reanimationsmaßnahmen erfolglos waren. Selbst vor dem Hintergrund vieler positiver Fallberichte bleibt die Indikation jedoch eine Einzelfallentscheidung. Da die Komplikationsrate maßgeblich vom vorausgegangenen Eingriff abhängig ist, muss das Blutungsrisiko in einer Nutzen-Risiko-Abwägung abgeschätzt werden. Aktuell liegen zur perioperativen Lysetherapie keine ausreichenden Untersuchungen vor, die einen Vorteil eines Therapieschemas gegenüber einem anderen Therapieschema aufzeigen. Eine perioperative Lyse ist nach jetziger Datenlage zeitlich eng zu begrenzen, da die Blutungsgefahr stärker von der Therapiedauer als von der Dosierung der Thrombolytika oder vom verwendeten Thrombolytikum abhängig zu sein scheint.

Abstract

Until recently, perioperative thrombolysis has always been thought to be a contraindication, because of the risk of bleeding complications. However, many case reports now show that thrombolytic drugs can be successfully used in the perioperative period. Possible indications for perioperative thrombolysis are massive pulmonary embolism and cardiopulmonary resuscitation which are also important causes of cardiac arrest. Thrombolysis can be the decisive therapeutical option, e.g. when normal cardiopulmonary resuscitation measures are not successful. Nevertheless, even against the background of many positive case reports the indication for perioperative thrombolysis should be a case-specific decision as the frequency of complications depends on the surgical intervention and must be weighed against the possible benefits of early thrombolysis. For perioperative thrombolysis there are no data available showing a beneficial effect of one particular therapeutic regimen. In the literature it is suggested that thrombolysis should be performed as quickly as possible, because the risk of bleeding complications depends more on the duration of thrombolysis than on the dosage or the thrombolytic drug itself.

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  1. Klinik für Anaesthesiologie, Universitätsklinikum, Heidelberg

    F. Spöhr, B. W. Böttiger & A. Walther

  2. Klinik für Anaesthesiologie, Universitätsklinikum, Im Neuenheimer Feld 110, 69120, Heidelberg

    F. Spöhr

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Spöhr, F., Böttiger, B.W. & Walther, A. Fehler und Gefahren der perioperativen Lysetherapie. Anaesthesist 54, 485–494 (2005). https://doi.org/10.1007/s00101-005-0828-z

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