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Diagnostik der Rezidivthrombose

Leitlinien und Empfehlungen

  • Schwerpunkt_Angiologie
  • Published:
CardioVasc Aims and scope

Zusammenfassung

Die tiefe Beinvenenthrombose ist eine chronische Erkrankung mit einem fortdauernden Risiko für ein Rezidiv. Tritt ein Rezidiv ein, sind Prognose und Behandlung des Patienten deutlich verändert, wobei beide ihre spezifischen Risiken nicht nur in der Akutphase, sondern besonders im Langzeitverlauf haben. Daher ist die korrekte Diagnose eines Rezidivs von größter Bedeutung. Die Diagnose einer ersten Episode folgt gut fundierten Algorithmen, mit den Elementen klinische Vortestwahrscheinlichkeit, D-Dimer-Test und Kompressionsultraschall der Beinvenen. Die Effizienz aller drei Elemente ist bei einem Patienten mit Verdacht auf ein Rezidiv durch die vorhergehende Episode verschlechtert. Dies gibt Raum für klinische Unsicherheiten, der nur mit persönlicher Einschätzung auf der Basis von Erfahrung gefüllt werden kann. Die verfügbaren Leitlinien spiegeln diesen Umstand wider, indem sie überwiegend schwache Empfehlungen auf der Grundlage nur weniger Daten geben. Die vorliegende Übersicht fasst zusammen, was über die einzelnen diagnostischen Werkzeuge bekannt ist, diskutiert jüngste Leitlinien und gibt schließlich Empfehlungen aufgrund einer persönlichen Gewichtung. Es stellt sich heraus, dass der für eine erste Episode gültige Algorithmus auch bei der Diagnose des Rezidivs verwendet werden kann, wenn man sich der schlechteren Effizienz bewusst ist. Der Ultraschall profitiert wesentlich, wenn ein Vorbefund vom Behandlungsende der vorausgegangenen Episode vorliegt. Mit welchem der verfügbaren Werkzeuge man im Einzelfall beginnt, kann durchaus an lokale oder regionale Gewohnheiten angepasst werden.

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Authors and Affiliations

  1. II. Medizinische Klinik Krankenhaus Dresden-Friedrichstadt, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Friedrichstrasse 41, 01067, Dresden, Deutschland

    Sebastian M. Schellong

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Schellong, S.M. Diagnostik der Rezidivthrombose. CV 13, 33–36 (2013). https://doi.org/10.1007/s15027-013-0269-6

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