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Gerinnungsmanagement beim Polytrauma

Management of coagulation after multiple trauma

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Zusammenfassung

Große Blutverluste bei schweren Verletzungen verursachen durch den Verlust an Gerinnungsfaktoren und Thrombozyten eine Gerinnungsstörung. Verdünnung von Gerinnungsfaktoren durch Kristalloide und Kolloide, gesteigertes fibrinolytisches Potenzial, Hypothermie, metabolische Veränderungen und Anämie beeinträchtigen ebenfalls das Hämostasegleichgewicht. Für die Therapie ist ein engmaschiges Monitoring des aktuellen Gerinnungsstatus unerlässlich. „Point-of-care-taugliche“ Geräte können Zeitintervalle bis zum Vorliegen des aktuellen Gerinnungsstatus verkürzen. Therapiert wird v. a. mit Frischplasmen (FFP), Thrombozytenkonzentraten und Antifibrinolytika. Gerinnungsfaktorenkonzentrate sind indiziert, wenn ein Faktorenmangel isoliert besteht, FFP nicht zur Verfügung stehen oder die Gerinnungsstörung bereits so ausgeprägt ist, dass mit Transfusion von FFP allein keine Besserung eintritt. Der rekombinate Faktor VIIa (NovoSeven®) wurde bereits bei vielen schweren Blutungen, die konventionell nicht sanierbar waren, eingesetzt. Die Ergebnisse großer klinischer Studien sind jedoch noch ausständig.

Abstract

Hemorrhage after traumatic injury results in coagulopathy which only worsens the situation. This coagulopathy is caused by depletion and dilution of clotting factors and platelets, increased fibrinolytic activity, hypothermia, metabolic changes and anemia. The effect of synthetic colloids used for compensating the blood loss, further aggravates the situation through their specific action on the hemostatic system. Bedside coagulation monitoring permits relevant impairment of the coagulation system to be detected very early and the efficacy of the hemostatic therapy to be controlled directly. Administration of fresh frozen plasma (FFP), platelet concentrates and antifibrinolytic agents is essential for restoring the impaired coagulation system in trauma patients. Clotting factor concentrates should be administered if coagulopathy is based on diagnosed depletion of clotting factors, if FFP is not available and if transfusion of FFP is insufficient to treat the coagulopathy. Recombined FVIIa is frequently employed during severe bleeding which could not be treated by conventional methods but the results of on-going clinical trials are not yet available.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck

    D. Fries, T. Haas, V. Salchner, K. Lindner & P. Innerhofer

  2. Universitätsklinik für Anästhesie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    D. Fries

Authors
  1. D. Fries
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  2. T. Haas
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  3. V. Salchner
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  4. K. Lindner
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  5. P. Innerhofer
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Corresponding author

Correspondence to D. Fries.

Internetlinks und Kontaktadressen

Internetlinks und Kontaktadressen

Arbeitsgruppe für perioperative Gerinnungstherapie der Österreichischen Gesellschaft für Anaesthesiologie, Reanimation und Intensivmedizin (ÖGARI)

  • Ansprechpartner:

  • Univ. Doz. Dr. Thomas Pernerstorfer

  • Wels, Österreich

  • e-mail: thomas.pernerstorfer@univie.at

  • Network of Advancement of Transfusion Alternatives (NATA).

  • Homepage: http://www.nataonline.org

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Fries, D., Haas, T., Salchner, V. et al. Gerinnungsmanagement beim Polytrauma. Anaesthesist 54, 137–144 (2005). https://doi.org/10.1007/s00101-004-0760-7

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  • DOI: https://doi.org/10.1007/s00101-004-0760-7

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