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Eingriff-spezifische Thromboseprophylaxe beim Erwachsenen

Perioperative thromboprophylaxis in adults

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Summary

According to the concept of Virchow, alterations of the blood flow, vascular injury and hypercoagulability of the blood (due to inherited or acquired thrombophilia or as a consequence of perioperative coagulation activation) are causally related to the risk of venous thrombosis. The overall risk of venous thromboembolic events in the perioperative setting ranges between <10% and >50%. The risk is highest in patients undergoing major orthopaedic surgery or cancer surgery. The aim of perioperative thrombosis prophylaxis is to reduce perioperative morbidity and mortality. The article discusses patient- and intervention-dependent thromboprophylactic measures. Recent recommendations for non-pharmacological and pharmacological prophylaxis are presented including the information on the beginning and duration of anticoagulation. Management strategies for patients undergoing abdominal and orthopaedic surgery as well as special aspects of the neurosurgical population and of cancer surgery are highlighted.

Zusammenfassung

Veränderungen des Blutflusses, Gefäßwandverletzungen und eine gesteigerte Gerinnbarkeit des Blutes durch angeborene oder erworbene Thrombophilie oder durch die perioperative Gerinnungsaktivierung tragen gemäß dem Konzept von Virchow ursächlich zur Entstehung von perioperativen Venenthrombosen bei. Je nach Art des Eingriffs beträgt das Risiko zwischen <10% und >50%. Das Risiko ist nach großen orthopädischen Eingriffen und bei Tumoroperationen am höchsten. Ziel einer standardisierten perioperativen Thromboseprophylaxe ist, die postoperative Morbidität und Mortalität zu senken. Dieser Artikel beschreibt Patienten- und Eingriff-spezifische Maßnahmen zur Thromboseprophylaxe. Aktuelle Empfehlungen zur mechanischen und pharmakologischen Prophylaxe einschließlich Beginn und Dauer der Antikoagulation werden dargestellt. Neben der Thromboseprophylaxe für allgemeinchirurgische und große orthopädische Eingriffe wird die Problematik auch am Beispiel neurochirurgischen Interventionen und der Tumorchirurgie beleuchtet.

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  1. Klinische Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Austria

    Sabine Eichinger

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  1. Sabine Eichinger
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Correspondence to Sabine Eichinger.

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Eichinger, S. Eingriff-spezifische Thromboseprophylaxe beim Erwachsenen. Wien Med Wochenschr 159, 475–480 (2009). https://doi.org/10.1007/s10354-009-0711-7

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