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Direkte Thrombininhibitoren

Eine Alternative zu Heparin während extrakorporaler Zirkulation?

Direct thrombin inhibitors

An alternative to heparin during extracorporeal circulation?

  • Kardiotechnik/EKZ
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Trotz zahlreicher Weiterentwicklungen der Herz-Lungen-Maschine (HLM) in den letzten Jahrzehnten ist unfraktioniertes Heparin nach wie vor der Goldstandard für die intraoperative Antikoagulation.

Ist infolge einer nach vorangegangener Heparinexposition entwickelten heparininduzierten Thrombozytopenie (HIT) Typ II eine alternative Antikoagulation während extrakorporaler Zirkulation (EKZ) erforderlich, stehen verschiedene Präparate zur Verfügung: Während aufgrund der aktuellen Studienlage für Thrombozytenaggregationshemmer und Danaparoid keine evidenzbasierte Empfehlung ausgesprochen werden kann, liegen für die direkten Thrombininhibitoren vielversprechende Ergebnisse vor. Insbesondere Bivalirudin, das eine sehr günstige Pharmakokinetik aufweist, kann für Patienten mit HIT Typ II als Antikoagulans während extrakorporaler Zirkulation empfohlen werden. Um entscheiden zu können, ob dieses Präparat auch bei HIT-negativen Patienten eine mindestens gleichwertige Alternative zu unfraktioniertem Heparin darstellt, werden weiterführende Studien benötigt.

Abstract

Over the past few decades, numerous improvements in several components of the heart–lung machine have been made. However, unfractionated heparin is still the state-of-the-art anticoagulant during extracorporeal circulation.

If a preoperative cardiosurgical patient suffers from heparin-induced thrombocytopenia (HIT) type II, alternative anticoagulatory agents are necessary. However, reviewing the existing studies, particularly with regard to criteria for evidence-based medicine, platelet aggregation inhibitors and danaparoid cannot be recommended. On the contrary, direct thrombin inhibitors are promising substances. Especially bivalirudin, which has favorable pharmacokinetic properties, seems to be an appropriate anticoagulant for patients with HIT type II. In order to determine whether bivalirudin could become a standard agent for intraoperative anticoagulation even in patients without blood coagulation disorders, further evidence-based trials are necessary.

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  1. Klinik für Kardiovaskuläre Chirurgie, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    A. Assmann, U. Boeken, P. Feindt & A. Lichtenberg

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  1. A. Assmann
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  2. U. Boeken
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  3. P. Feindt
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  4. A. Lichtenberg
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Correspondence to A. Assmann.

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Assmann, A., Boeken, U., Feindt, P. et al. Direkte Thrombininhibitoren. Z Herz- Thorax- Gefäßchir 24, 127–133 (2010). https://doi.org/10.1007/s00398-010-0777-y

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  • DOI: https://doi.org/10.1007/s00398-010-0777-y

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