Zusammenfassung
Wir berichteten über eine junge Fußballspielerin, die im Alter von 21 Jahren zunächst eine transitorisch ischämische Attacke und ein halbes Jahr später einen akuten Myokardinfarkt bei zugleich bestehender Thrombozytopenie erlitt. Ursache hierfür war ein Antiphospholipidsyndrom. Dieses Erkrankungsbild wird durch eine sehr heterogene Gruppe von Antiphospholipidantikörpern ausgelöst. Diese greifen an verschiedenen Stellen der plasmatischen Gerinnung ein und vermögen Thrombozyten, Endothelzellen wie auch Monozyten zu aktivieren. Dies führt zu einem thrombophilen Zustand, welcher sich klinisch durch das rezidivierende Auftreten von venösen Thrombosen, arteriellen Embolien oder Frühgeburten bzw. Aborten manifestiert. Therapeutisch stehen deshalb orale Antikoagulation, Heparine und Aspirin im Vordergrund. Bei ausgeprägten Thrombozytopenien werden Steroide und bei deren Versagen auch Immunsuppressiva empfohlen.
Gerade bei jungen Patienten mit thromboembolischen Ereignissen sollte an das Antiphospholipidsyndrom gedacht werden, da sich innerhalb dieser Patientengruppe zu 10–20% Antiphospholipidantikörper nachweisen lassen und eine effektive Therapie nach Diagnosestellung das Rezidivrisiko senkt.
Abstract
We report on a case of a young female soccer player who first experienced a transient ischemic attack at the age of 21 and then suffered an acute myocardial infarction accompanied by thrombocytopenia 6 months later. The underlying cause was antiphospholipid syndrome. This clinical picture is caused by a very heterogeneous group of antiphospholipid antibodies, which interfere with plasmatic coagulation at various sites and are able to activate thrombocytes, endothelial cells, and monocytes. This leads to a thrombophilic condition with clinical manifestation of recurrent venous thromboses, arterial embolisms, or premature birth or miscarriage. The main therapeutic options are thus anticoagulation, heparins, and aspirin. Steroids are recommended for cases of pronounced thrombocytopenias; if treatment fails, immunosuppressants are also advisable.
The antiphospholipid syndrome should be kept in mind especially in cases of young patients with thromboembolic events since the presence of antiphospholipid antibodies can be detected in 10–20% of this patient group and effective therapy after diagnosis lowers the rate of recurrence.
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Rank, A., Lindner, L. & Hiller, E. 21-jährige Patientin mit Myokardinfarkt, TIA und Thrombozytopenie. Internist 44, 349–353 (2003). https://doi.org/10.1007/s00108-002-0811-6
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DOI: https://doi.org/10.1007/s00108-002-0811-6
Schlüsselwörter
- Antiphospholipidsyndrom
- Myokardinfarkt
- Thrombozytopenie
- Thromboembolie
- Transitorisch ischämische Attacke