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Thromboembolieprophylaxe und überbrückende Antikoagulation

Strategien in der HNO-Heilkunde

Prophylaxis of venous thromboembolism and anticoagulation bridging

Strategies in otorhinolaryngology

HNO volume 58, pages 770–777 (2010)Cite this article

Zusammenfassung

Verschiedene interdisziplinäre Leitlinien empfehlen eine medikamentöse venöse Thromboembolie- (VTE-)Prophylaxe bei stationären Patienten mit erhöhtem Risiko. Niedermolekulare Heparine und Fondaparinux haben sich aufgrund ihrer im Vergleich zu unfraktioniertem Heparin günstigeren pharmakologischen Eigenschaften zur VTE-Prophylaxe in der operativen und nichtoperativen Medizin bewährt. Wenn bei Patienten unter dauerhafter oraler Antikoagulation mit Vitamin-K-Antagonisten ein größerer chirurgischer Eingriff ansteht, muss auf Antikoagulanzien mit kürzerer Halbwertszeit umgestellt werden (überbrückende Antikoagulation). Hierzu eignen sich niedermolekulare Heparine am besten; ihre Wirksamkeit und Sicherheit ist durch zahlreiche Studien belegt. Dennoch sind die niedermolekularen Heparine für die überbrückende Antikoagulation nicht behördlich zugelassen. In der HNO-Heilkunde existieren bislang keine detaillierten Empfehlungen zur peri- bzw. postoperativen VTE-Prophylaxe, obwohl häufig Patienten mit signifikantem VTE-Risiko operiert werden. Es wird ein Schema zur medikamentösen VTE-Prophylaxe und zur überbrückenden Antikoagulation in der HNO-Heilkunde vorgeschlagen.

Abstract

Various interdisciplinary guidelines recommend that in-patients at risk of venous thromboembolism should receive pharmacologic prophylaxis. Among the anticoagulants low-molecular-weight heparins (LMWH) and fondaparinux can be considered the medications of choice because of the favorable pharmacokinetic properties when compared with unfractionated heparin. Treatment with vitamin K antagonists has to be interrupted in patients undergoing major surgery or invasive procedures. Oral anticoagulation has to be temporarily replaced by short-acting anticoagulants such as LMWH in order to prevent thromboembolic complications (anticoagulation bridging). Although LMWHs have not been approved for this clinical setting their efficacy and safety has been demonstrated in several recent studies. Detailed recommendations for prophylaxis of venous thromboembolism in otorhinolaryngology are lacking although numerous surgical procedures are considered to be associated with a significant risk of thromboembolism. A strategy for pharmacologic prophylaxis of venous thromboembolism and anticoagulation bridging in otorhinolaryngology is proposed.

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Literatur

  1. Bauersachs R, Schellong SM, Haas S et al (2007) Überbrückung der oralen Antikoagulation bei interventionellen Eingriffen. Dtsch Arztebl 104:A 1237–1244

    Google Scholar 

  2. Cohen AT, Tapson VF, Bergman JF et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394

    Article  PubMed  Google Scholar 

  3. Douketis JD, Berger PB, Dunn AS et al (2008) The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8. Aufl). Chest 133 [Suppl]:299–339

    Google Scholar 

  4. Douketis JD, Johnson JA, Turpie AG (2004) Low-molecular-weight heparin as bridging anticoagulation during interruption of warfarin: assessment of a standardized periprocedural anticoagulation regimen. Arch Intern Med 164:1319–1326

    Article  CAS  PubMed  Google Scholar 

  5. Encke A, Haas S, Krauspe R et al (2003) Stationäre und ambulante Thromboembolieprophylaxe in der Chirurgie und der perioperativen Medizin. Phlebologie 32:164–169

    Google Scholar 

  6. Encke A, Haas S, Sauerland S et al (2009) Prophylaxe der venösen Thromboembolie (VTE). Vasa 38 (S76):1–131

    Article  Google Scholar 

  7. Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College Of Chest Physicians Evidence-Based Clinical Practice Guidelines (8. Aufl). Chest 133 [Suppl]:381–453

    Google Scholar 

  8. Geerts WH, Code KI, Jay RM et al (1994) A prospective study of venous thromboembolism after major trauma. N Engl J Med 331:1601–1606

    Article  CAS  PubMed  Google Scholar 

  9. Greinacher A, Lubenow N, Hinz P et al (2003) Heparininduzierte Thrombozytopenie. Dtsch Arztebl 100:A2220–A2229

    Google Scholar 

  10. Hull RD, Pineo GF, Francis C et al (2000) Low-molecular-weight heparin prophylaxis using dalteparin in close proximity to surgery vs warfarin in hip arthroplasty patients. Arch Intern Med 160:2199–2207

    Article  CAS  PubMed  Google Scholar 

  11. Jámbor C, Spannagl M, Zwissler B (2009) Perioperatives Management von Patienten mit Koronarstents bei nichtherzchirurgischen Eingriffen. Anaesthesist 58:971–985

    Article  PubMed  Google Scholar 

  12. Leizorovicz A, Cohen AT, Turpie AG et al (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 110:874–879

    Article  CAS  PubMed  Google Scholar 

  13. Nicolaides AN, Fareed J, Kakkar AK et al (2006) Prevention and treatment of venous thromboembolism. International consensus statement (guidelines according to scientific evidence). Int Angiol 25:101–161

    Google Scholar 

  14. Poldermans D, Bax JJ, Boersma E et al (2009) Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 30:2769–2812

    Article  PubMed  Google Scholar 

  15. Sajid MS, Tai NR, Goli G et al (2006) Knee versus thigh length graduated compression stockings for prevention of deep venous thrombosis: a systematic review (2006). Eur J Vasc Endovasc Surg 32:730–736

    Article  CAS  PubMed  Google Scholar 

  16. 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. N Engl J Med 341:793–800

    Article  CAS  PubMed  Google Scholar 

  17. Schellong SM, Halbritter K, Haas S (2007) Überbrückende Antikoagulation. Chirurg 78:125–132

    Article  CAS  PubMed  Google Scholar 

  18. Shackford SR, Davis JW, Hollingsworth-Fridlund P et al (1990) Venous thromboembolism in patients with major trauma. Am J Surg 159:365–369

    Article  CAS  PubMed  Google Scholar 

  19. Spyropoulos AC, Brotman DJ, Amin AN et al (2008) Prevention of venous thromboembolism in the cancer surgery patient. Cleve Clin J Med 75 [Suppl]:S17–S26

  20. Strebel N, Prins M, Agnelli G et al (2002) Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery? Arch Intern Med 162:1451–1456

    Article  CAS  PubMed  Google Scholar 

  21. Tapson VF, Decousus H, Pini M et al (2007) Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. Chest 132:936–945

    Article  PubMed  Google Scholar 

  22. White RH, Zhou H, Gage BF (2004) Effect of age on the incidence of venous thromboembolism after major surgery. J Thromb Haemost 2:1327–1333

    Article  CAS  PubMed  Google Scholar 

  23. Zotz RB, Kauschat-Brüning D, Bramlage P (2009) Thromboembolic risk and prophylaxis in hospitalized surgical and internal medicine patients. German results of the international ENDORSE study. Dtsch Med Wochenschr 134:2163–2169

    Article  CAS  PubMed  Google Scholar 

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Affiliations

  1. Hals-Nasen-Ohrenklinik, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland

    J. Deutsch & K.-W. Delank

  2. Institut für Hämostaseologie und Transfusionsmedizin, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland

    H. Haubelt & P. Hellstern

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  1. J. Deutsch
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  2. H. Haubelt
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  3. P. Hellstern
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  4. K.-W. Delank
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Deutsch, J., Haubelt, H., Hellstern, P. et al. Thromboembolieprophylaxe und überbrückende Antikoagulation. HNO 58, 770–777 (2010). https://doi.org/10.1007/s00106-010-2138-2

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  • DOI: https://doi.org/10.1007/s00106-010-2138-2

Schlüsselwörter

  • Thromboembolieprophylaxe
  • Überbrückende Antikoagulation
  • Blutung
  • Orale Antikoagulation
  • Niedermolekulare Heparine

Keywords

  • Oral anticoagulation
  • Venus thromboembolism prophylaxis
  • Anticoagulation bridging
  • Bleeding
  • Low-molecular-weight heparins