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Thromboembolieprophylaxe in der Chirurgie

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Zusammenfassung

Eine routinemäßige Thromboseprophylaxe ist fester Bestandteil der chirurgischen Behandlung. Die Indikationsstellung und Wahl der Prophylaxeform erfolgen in Abhängigkeit vom individuellen Risikoprofil des Patienten, welches durch Kombination von expositionellen und dispositionellen Risikofaktoren bestimmt wird. Das expositionelle Risiko ist durch Art und Umfang des chirurgischen Eingriffs bzw. Traumas geprägt, wogegen das dispositionelle Risiko patientenbezogene Risikofaktoren beinhaltet. In der nachfolgenden Übersicht wird ein Überblick über die aktuellen Prophylaxemethoden, ihre pharmakologischen Details und ihre klinische Relevanz gegeben. Vor dem Hintergrund evidenzbasierter Daten und der Empfehlungen der Fachgesellschaften wird auch zur Dauer der Prophylaxe und zu forensischen Fragen Stellung bezogen. Die Entwicklung neuer Medikamente vergrößert die Bandbreite der Prophylaxeprinzipien und schafft neuen Informationsbedarf.

Abstract

Prophylactic treatment against deep vein thrombosis has become a routine part of surgical treatment. The indications and the form of prophylaxis selected depend on the patient’s individual risk profile, which is determined in turn by a combination of exposing and predisposing risk factors. The exposing risk factors depend on the type of surgery and trauma the patient is exposed to, while the predisposing risks are determined by factors peculiar to the patient. This review deals with the modalities of prophylaxis currently available, pharmacological details relating to these, and their clinical significance. In addition, evidence-based data, recommendations for the duration of prophylaxis derived from official guidelines, and medicolegal aspects are discussed. The development of new anticoagulants is expanding the range of prophylactic methods, which means further information is needed.

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Literatur

  1. Agu O, Hamilton G, Baker D (1999) Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg 86: 992–1004

    Article  CAS  PubMed  Google Scholar 

  2. AWMF (2003) Leitlinie zu rückenmarknahen Regionalanästhesien und Thromboembolieprophylaxe/Antikoagulation. Anästhesiol Intensivmed 44: 218–230

  3. AWMF (2003) Leitlinie zur stationären und ambulanten Thromboembolieprophylaxe in der Chirurgie und der perioperativen Medizin. AWMF-Leitlinien-Register Nr 003/001

  4. Bertina RM, Koeleman BP, Koster T et al. (1994) Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 369: 64–67

    CAS  PubMed  Google Scholar 

  5. Bertina RM, Reitsma PH, Rosendaal FR, Vandenbroucke JP (1995) Resistance to activated protein C and factor V Leiden as risk factor for venous thrombosis. Thromb Haemost 74:4 49–453

    Google Scholar 

  6. Dahl OE, Aspelin T, Arnesen H et al. (1995) Increased activation of coagulation and formation of late deep venous thrombosis following discontinuation of thromboprophylaxis after hip replacement surgery. Thromb Res 80: 299–306

    Article  CAS  PubMed  Google Scholar 

  7. Dahl OE, Gudmundsen TE, Haukeland L (2000) Late occuring clinical deep vein thrombosis in joint-operated patients. Acta Orthop Scand 71: 47–50

    Article  CAS  PubMed  Google Scholar 

  8. Dahlbäck B, Carlsson M, Svensson PJ (1993) Familial thrombosis due to a previously unrecognized mechanism characterized by poor anticoagulant response to activated protein C: prediction of a cofactor to activated protein C. Proc Natl Acad Sci USA 90: 1004–1008

    PubMed  Google Scholar 

  9. Eriksson BI (2003) Clinical experience of melagatran/ximelagatran in major orthopaedic surgery. Thromb Res Suppl 10: S23–2912,13

    Article  Google Scholar 

  10. Eriksson BI, Lassen MR (2003) Pentasaccharide in hip-fracture surgery plus investigators: duration of prophylaxis against venous thromboembolism with Fondaparinux after hip fracture surgery: a multicenter, randomised, placebo-controlled, double-blind study. Arch Intern Med 163: 1337–1342

    Article  CAS  PubMed  Google Scholar 

  11. Eriksson BI, Agnelli G, Cohen AT et al. (2003) Direct thrombin inhibitor melagatran followed by oral ximelagatran in comparison with enoxaparin for prevention of venous thromboembolism after total hip or knee replacement. Thromb Haemost 89: 288–296

    CAS  PubMed  Google Scholar 

  12. Geerts WH, Heit JA, Clagett GP et al. (2001) Prevention of venous thromboembolism. Chest 119: 132

    Article  Google Scholar 

  13. Gustafsson D, Elg M (2003) The pharmacodynamics and pharmacokinetics of the oral direct thrombin inhibitor ximelagatran and its active metabolite melagatran: a mini-review. Thromb Res [Suppl 1] 109: S9–15

  14. Hirsh J, Warkentin TE, Shaughnessy SG et al. (2001) Heparin and low-molecular-weight heparin. Chest [Suppl] 119: 64S–94S3

  15. Hull RD, Pineo GF (1999) Extended prophylaxis against venous thromboembolism following total hip and knee replacement. Haemostasis [Suppl 1] 29: 23–31

  16. Mizel MS, Temple HAT, Michelson JD (1998) Thromboembolism after foot and ankle surgery. A multicenter study. Clin Orthop 348: 180–185

    PubMed  Google Scholar 

  17. Turpie AG, Bauer KA, Eriksson BI, Lassen MR (2002) Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Intern Med 162: 1833–1840

    Article  PubMed  Google Scholar 

  18. Ulsenheimer K (2001) Rechtliche Aspekte bei der Phrophylaxe und Therapie der venösen Thrombose. Chirurg 4: 104–110

    Google Scholar 

  19. Virchow R (1856) Phlogose und Thrombose im Gefäßsystem. Gesammelte Abhandlungen zur wissenschaftlichen Medicin. Meininger, Berlin III: 458–635

  20. Warkentin TE, Elavathil LJ, Hayward CP et al. (1997) The pathogenesis of venous limb gangrene associated with heparin-induced thrombocytopenia. Ann Intern Med 127: 804–812

    CAS  PubMed  Google Scholar 

  21. Wells PS, Lensing AWA, Hirsh J (1996) Graduated compression stockings in the prevention of postoperative venous thromboembolism. A meta-analysis. Arch Intern Med 154: 67–72

    Article  Google Scholar 

  22. Wilson D, Cooke EA, McNally MA, Wilson HK, Yeates A, Mollan RA (2001) Changes in coagulability as measured by thrombelastography following surgery for proximal femoral fracture. Injury 32: 765–770

    Article  CAS  PubMed  Google Scholar 

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  1. Institut für Experimentelle Onkologie und Therapieforschung, Klinikum rechts der Isar, Technische Universität München

    S. Haas

  2. Institut für Experimentelle Onkologie und Therapieforschung, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 , München

    S. Haas

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Haas, S. Thromboembolieprophylaxe in der Chirurgie. Chirurg 75, 323–343 (2004). https://doi.org/10.1007/s00104-004-0854-4

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