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Heparin-induzierte Thrombozytopenie (HIT) bei Operationen unter Verwendung der Herz-Lungen-Maschine und bei Patienten mit mechanischer Kreislaufunterstützung

Heparin-induced thrombocytopenia in cardiopulmonary bypass surgery and in patients with mechanical assist devices

  • ORIGINALARBEIT
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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Heparin-induzierte Thrombozytopenie (HIT) ist eine seltene, aber lebensbedrohliche unerwünschte Wirkung der Heparintherapie. Zu den therapeutischen Prinzipien gehören die Vermeidung von Heparin sowie die alternative Antikoagulation. Dies gestaltet sich bei HIT-Patienten, die einen Eingriff mit extrakorporaler Zirkulation oder eine mechanische Kreislaufunterstützung benötigen, problematisch: Oft besteht an extrakorporalen Kreisläufen nur geringe Erfahrung im Umgang mit den alternativen Medikamenten. Außerdem haben alle alternativen Substanzen spezifische Vor- und Nachteile. Die Auswahl muss deshalb individuell anhand von Patienteneigenschaften und lokalen Möglichkeiten erfolgen. Dieser Beitrag stellt die verfügbaren Konzepte der alternativen Antikoagulation an extrakorporalen Kreisläufen vor und bewertet sie anhand der aktuellen Literatur und persönlicher Erfahrungen.

Abstract

Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening adverse effect of heparin therapy. Immediate cessation of heparin and alternative anticoagulation are basic therapeutic principles of HIT. This is especially difficult in HIT patients requiring cardiopulmonary bypass surgery or mechanical circulatory assists. Limited experience with alternative drugs in this setting and disadvantages of all possible alternative drugs demand an individual choice based on patient- and site depending considerations. This article provides a review of the different options of alternative anticoagulation for cardiopulmonary bypass surgery and mechanical assist devices. Advantages and disadvantages are assessed based on the literature and on personal experience.

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Authors and Affiliations

  1. Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt Universität Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany

    S. Selleng &  A. Greinacher

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  1. S. Selleng
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  2. A. Greinacher
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Correspondence to A. Greinacher.

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Selleng, S., Greinacher, A. Heparin-induzierte Thrombozytopenie (HIT) bei Operationen unter Verwendung der Herz-Lungen-Maschine und bei Patienten mit mechanischer Kreislaufunterstützung. Z Herz- Thorax- Gefäßchir 21, 198–205 (2007). https://doi.org/10.1007/s00398-007-0592-2

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  • DOI: https://doi.org/10.1007/s00398-007-0592-2

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