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Thrombophile Gerinnungsstörungen bei peripherer arterieller Verschlusskrankheit

Mit besonderer Berücksichtigung der rekonstruktiven Gefäßchirurgie

Disturbances of coagulation predisposing to thrombosis in peripheral arterial occlusive disease

With special reference to reconstructive vascular surgery

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Zusammenfassung

Die Atherosklerose mit ihren klassischen Risikofaktoren ist für die Entstehung von arteriellen Thrombosen bei peripherer arterieller Verschlusskrankheit (pAVK) und bei Bypassverschlüssen von vorrangiger Bedeutung. Thrombophile Gerinnungsstörungen können das Thromboserisiko zusätzlich begünstigen. Zahlreiche Studien legen einen gewissen Zusammenhang zwischen einzelnen oder mehreren Gerinnungsdefekten und einer Progredienz der arteriellen Verschlusskrankheit bzw. einem Bypassverschluss nahe, wobei unter allen Einzelfaktoren des Gerinnungssystems dem Fibrinogen die größte Bedeutung bezüglich der Schwere und Progredienz von arteriellen Gefäßverschlüssen eingeräumt wird.

Ein eindeutiger kausaler Zusammenhang ist aber noch nicht bewiesen. Die Ergebnisse sind für ein und denselben Parameter oft widersprüchlich. Die Studiendesigns sind zu heterogen und die Fallzahlen zu klein. Es fehlen größere prospektive randomisierte Studien, die ein verbessertes Ergebnis für gefährdete Patienten nach spezieller medikamentöser therapeutischer Intervention belegen. Homocystein und Antiphospholipid-Antikörper (APL-AK) erscheinen besonders gut geeignet für entsprechende Studien, da hierbei mit einer Vitaminsupplementation bzw. mit speziellen antikoagulatorischen Therapieregimes gezielte medikamentöse Interventionsmöglichkeiten zur Verfügung stehen.

Abstract

Atherosclerosis, with its classic risk factors, has an extremely important place in the development of arterial thromboses in the presence of peripheral arterial occlusive disease (PAOD) and of bypass occlusions. Thrombophilic disturbances of coagulation can compound the risk of thrombosis further. Numerous studies provide a warning that there may be some connection between single or multiple coagulation defects and progression of arterial occlusive disease and/or occlusion of a bypass, fibrinogen being considered the most significant of all the individual risk factors with respect to severity and progression.

However, no unequivocal causal connection has so far been confirmed. The results for one and the same parameter are frequently contradictory. The study designs vary too widely, and the case numbers are too low. No large prospective randomized studies are available documenting better results for at-risk patients following specific drug interventions. Homocysteine and antiphospholipid antibodies (APL Ab) appear to be particularly suitable for use in corresponding studies, as these would mean that with vitamin supplementation and/or specific anticoagulant regimens targeted medicamentous treatment options are available.

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  1. Gefäßzentrum am Krankenhaus Nordwest , Steinbacher Hohl 2–26, 60488, Frankfurt, Deutschland

    V. Hach-Wunderle &  M. Zegelman

  2. Venenzentrum Frankfurt, Fahrgasse 89, 60311, Frankfurt/Main, Deutschland

    V. Hach-Wunderle &  W. Hach

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  1. V. Hach-Wunderle
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  2. M. Zegelman
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Hach-Wunderle, V., Zegelman, M. & Hach, W. Thrombophile Gerinnungsstörungen bei peripherer arterieller Verschlusskrankheit. Gefässchirurgie 11, 325–333 (2006). https://doi.org/10.1007/s00772-006-0482-z

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