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Pathophysiologie, Klinik und Therapie intensivmedizinischer Krankheitsbilder mit DIC

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Lebensbedrohliche Gerinnungsstörungen in der Intensivmedizin

Zusammenfassung

Die disseminierte intravasale Gerinnung — im englischsprachigen Bereich als „disseminated intravascular coagulation“ (DIC) bezeichnet — stellt sowohl vom diagnostischen als auch vom therapeutischen Standpunkt aus betrachtet ein komplexes Geschehen dar. Zahlreiche Erkrankungen können unabhängig voneinander eine DIC auslösen, die klinischen Erscheinungsbilder sind mannigfaltig, die diagnostischen Kriterien sind nicht einheitlich definiert, und verschiedene, z. T. noch experimentelle Therapiestrategien wurden für den Patienteneinsatz propagiert. Allgemeine Therapieempfehlungen sind kaum zu erstellen, da die Morbidität und die Überlebensrate hauptsächlich von der spezifischen DIC-Ursache abhängen, und da prospektive, randomisierte Multizenterstudien zur Verifizierung von Therapieeffekten nicht vorliegen.

Die DIC ist keine eigenständige Erkrankung, sondern tritt als Folgeerscheinung oder Komplikation von schweren Grundkrankheiten auf. Eine Gerinnungsaktivierung im Rahmen dieser Grundkrankheiten induziert eine überschießende intravasale Gerinnung, die sich in verschiedener Weise manifestieren kann. Zum einen führt sie zur Bildung und Ablagerung von Fibrin, so daß in multiplen Organen Mikrothrombosen entstehen. Zum anderen tritt ein Verbrauch von Gerinnungsfaktoren auf, der auf der extensiven und persistierenden Aktivierung des Gerinnungssystems beruht. Verstärkt wird dieser Verbrauch durch eine reduzierte Lebersyntheseleistung und durch eine verkürzte Halbwertszeit der Gerinnungsfaktoren, wobei diese Verkürzung durch die Proteasenaktivierung bedingt ist. Aufgrund eines solchen Verbrauchs und der auftretenden Thrombopenie können gleichzeitig mit den Mikrothrombosen schwere Blutungskomplikationen entstehen.

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  1. H. Böhrer
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  1. William-Harvey-Klink, Abt. für Innere Medizin, Am Kaiserberg 6, D-61231, Bad Nauheim, Deutschland

    Viola Hach-Wunderle

  2. Medizinische Klinik I, Universität Heidelberg, Bergheimer Straße 58, D-69115, Heidelberg, Deutschland

    Peter P. Nawroth

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Böhrer, H., Nawroth, P.P. (1996). Pathophysiologie, Klinik und Therapie intensivmedizinischer Krankheitsbilder mit DIC. In: Hach-Wunderle, V., Nawroth, P.P. (eds) Lebensbedrohliche Gerinnungsstörungen in der Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-12220-4_1

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