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Therapieoptionen der perioperativ erworbenen Thrombozytopathie

Therapeutic options for perioperatively acquired platelet dysfunctions

  • Klinische Pharmakologie
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Zusammenfassung

Erworbene Thrombozytenfunktionsstörungen können die Ursache für vermehrten intra- und postoperativen Blutverlust sein. Insbesondere weil die konventionelle Gerinnungsanalyse und die Bestimmung der Thrombozytenzahl das eingeschränkte Aggregationspotenzial von geschädigten Thrombozyten nicht abzubilden vermögen, ist die Implementierung bettseitiger Thrombozytenfunktionsdiagnostik in den perioperativen Bereich zur Detektion erworbener Thrombozytopathien nach den Ergebnissen retrospektiver Studien empfehlenswert. Nach einer adäquaten Korrektur der hämostaseologischen Rahmenbedingungen (Temperatur, pH, Ca2+-Konzentration und Hämatokrit) stellt der Versuch einer pharmakologischen Intervention mit Desmopressin (1-Desamino-8-D-argininvasopressin; DDAVP) oder Tranexamsäure eine kostengünstige und nebenwirkungsarme Alternative zur Transfusion von Thrombozytenkonzentraten dar.

Abstract

Increased intra-operative and postoperative blood loss might be caused by acquired platelet function disorders. In particular because conventional coagulation analyses and platelet count fail to detect impaired platelet function, implementation of bedside-tests for platelet function in the peri-operative period is desirable according to the results of retrospective studies. Following adequate adjustment of basic conditions of haemostasis (e.g. temperature, pH, Ca2+-concentration, haematocrit) a pharmacological approach with desmopressin (1-desamino-8-d-arginine vasopressin; DDAVP) or tranexamic acid potentially represents a low cost alternative to platelet transfusions with minor side effects.

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Interessenskonflikt

Der korrespondierende Autor und der Seniorautor weisen auf eine Verbindung mit folgenden Firmen hin: Herr Dr. C.F. Weber hat Honorar für wissenschaftliche Vorträge von der Firma CSL Behring erhalten. Herr Dr. K. Görlinger hat Honorar für wissenschaftliche Vorträge von den Firmen CSL Behring, Novo Nordisk, LFB, Pentapharm, Diagnostica Stago, Triolab und Instrumentation Laboratories erhalten. Die Präsentation des Themas ist unabhängig und in der Darstellung der Inhalte produktneutral.

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  1. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland

    C.F. Weber, A.C. Schneider, T. Kirschning & K. Zacharowski

  2. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    K. Görlinger

  3. Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsmedizin Mannheim, Mannheim, Deutschland

    C. Hofstetter

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Weber, C., Schneider, A., Kirschning, T. et al. Therapieoptionen der perioperativ erworbenen Thrombozytopathie. Anaesthesist 58, 931–940 (2009). https://doi.org/10.1007/s00101-009-1599-8

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