Zusammenfassung
Obwohl bis zu 80% der tödlichen Lungenembolien bei nicht-chirurgischen Patienten auftreten, liegen hierzu aussagekräftige Studien zur Thromboseprophylaxe erst seit 10 Jahren vor. Stationäre Patienten mit akuten internistischen Erkrankungen, die bettlägerig sind, bedürfen einer medikamentösen Thromboseprophylaxe mit unfraktioniertem oder niedermolekularem Heparin oder Fondaparinux, ebenso Patienten mit malignen Grunderkrankungen oder solche mit akutem ischämischem Schlaganfall und paretischem Bein. Herausforderungen bei der Thromboseprophylaxe ergeben sich bei der lückenlosen Fortsetzung der Prophylaxe nach Krankenhausentlassung bei fortbestehendem Risiko, bei der Indikationsstellung und Durchführung einer Thromboseprophylaxe im ambulanten Bereich sowie durch die Multimorbidität und das oftmals hohe Alter der internistischen Patienten. Letzteres bedingt nicht nur ein erhöhtes Thromboembolierisiko, sondern auch ein erhöhtes Blutungsrisiko, v. a. bei eingeschränkter Nierenfunktion oder plättchenhemmender Begleitmedikation. Produktspezifische Empfehlungen und Anwendungsbeschränkungen sind hier besonders zu beachten. Die Thromboseprophylaxe in der Inneren Medizin und im hausärztlichen Bereich ist eine wirksame Maßnahme, um symptomatische und tödliche Thromboembolien zu verhüten, erfordert aber wegen der Multimorbidität und Polymedikation eine sorgfältige Kontrolle.
Abstract
Although up to 80% of fatal pulmonary emboli occur in nonsurgical patients, conclusive studies on the prevention of thrombosis have only become available in the last 10 years. Bedridden inpatients with acute medical diseases require pharmacologic prophylaxis for thrombosis with unfractionated or low molecular weight heparin or with fondaparinux. This also holds true for patients with underlying malignancies or those suffering from acute ischemic stroke or paretic leg. The challenges to thrombosis prophylaxis are posed by ensuring that uninterrupted prophylaxis is continued after hospital discharge in cases of persisting risk, determining the indications and applying thrombosis prophylaxis on an outpatient basis as well as the multimorbidity and often advanced age of the internal medicine patients. The last factor not only entails an elevated risk of thromboembolism but also an increased risk of hemorrhage, especially in patients with renal insufficiency or platelet inhibitors. Product-specific recommendations and restrictions on pharmacologic prophylaxis need to be considered. Thromboprophylaxis as applied in internal medicine and family practice represents an effective measure to prevent symptomatic and fatal thromboembolisms, but due to multimorbidity and polytherapy of medical patients it requires careful monitoring.
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Interessenkonflikt
Prof. Dr. R. Bauersachs erhielt Vortragshonorare der Firmen GSK, Leo, Pfizer und Sanofi-Aventis, Prof. Dr. S. Haas erhielt Beratungshonorar der Firmen Novartis und Sanofi-Aventis.
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Bauersachs, R., Haas, S. Thromboembolieprophylaxe in der Inneren Medizin und der hausärztlichen Versorgung. Internist 51, 314–324 (2010). https://doi.org/10.1007/s00108-009-2512-x
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DOI: https://doi.org/10.1007/s00108-009-2512-x