Wiener Medizinische Wochenschrift

, Volume 161, Issue 3–4, pp 68–72 | Cite as

Thrombosis prophylaxis in critically ill patients

Themenschwerpunkt

Summary

Incidence of deep vein thrombosis in critically ill patients depends on the underlying disease but may be as high as 60%. The Surviving Sepsis Campaign clearly recommends administering anticoagulation in the absence of specific contraindications in patients with severe sepsis or septic shock. The article discusses risk factor for thromboembolic events in critical illness as well as means of non-pharmacologic and pharmacologic thrombosis prophylaxis. Peripheral vasoconstriction, edema, shock, and administration of catecholamines may reduce the bioavailability and efficacy of subcutaneous administration of low molecular weight heparin. This article further elaborates on the problem and pathophysiology of heparin resistance. Continuous intravenous administration of new anticoagulants may be a promising alternative to indirect anticoagulants. Severity of illness and SAPS II-score determine dosing of the direct thrombin inhibitor argatroban which needs to be about 10-times lower than in patients without critical illness.

Keywords

Venous thrombosis Drug therapy Critical illness 

Thromboseprophylaxe bei kritisch Kranken

Zusammenfassung

Die Häufigkeit von tiefen Beinvenenthrombosen bei Intensivpatienten wird in Abhängigkeit von der Grunderkrankung mit bis zu etwa 60 % angegeben. Die aktuellen Empfehlungen sind, obwohl die Datenlage in diesem selektioniertem Krankengut sehr spärlich ist, eindeutig: Die Surviving Sepsis Campaign Richtlinie fordert eine prophylaktische Antikoagulation bei Patienten mit schwerer Sepsis bzw. mit septischen Schock solange keine Kontraindikationen vorliegen. Dieser Artikel beschäftigt sich mit Risikofaktoren für das Auftreten einer Thromboembolie beim kritisch Kranken und mit Möglichkeiten der physikalischen und medikamentösen Antikoagulation. Periphere Vasokonstriktion, Schock sowie die Verabreichung von Katecholaminen, Ödem mit teilweise massiven Flüssigkeitsansammlungen als Folge der Flüssigkeitsretention v. a. im Bindegewebe sowie eine mitunter stark eingeschränkte Organfunktion lassen die Wirkung von subkutan verabreichten niedermolekularen Heparinen nicht sicher vorhersagen. Dieser Beitrag beschäftigt sich auch mit dem Problem der Heparin-Resistenz und den pathophysiologischen Ursachen. Die kontinuierliche intravenöse Applikation neuer Antikoagulantien könnte hier eine sinnvolle Alternative sein. Für den direkten Thrombininhibitor Argatroban gilt, dass je ausgeprägter die Erkrankung bzw. je höher der SAPS-II-Score, desto niedriger ist die erforderliche Dosis.

Schlüsselwörter

Venöse Thrombose Thromboseprophylaxe Intensivbehandlung 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of General and Surgical Intensive Care MedicineMedical University of InnsbruckInnsbruckAustria

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