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Möglichkeiten der lokalen und systemischen Blutstillung bei chirurgischen Eingriffen

Local and systemic hemostasis in surgery

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Zusammenfassung

Chirurgische Eingriffe führen unweigerlich zur Blutung. Blutstillung zielt auf Verminderung des intraoperativen Blutverlusts und Verminderung des Transfusionsbedarfs sowie auf Vermeidung von Nachblutung, Hämatomentwicklung und Vermeidung der Reoperation wegen Nachblutung. Verschiedene Mittel zur lokalen Blutstillung sind in Gebrauch wie Knochenwachs, Gelatine, oxidierte regenerierte Zellulose, Fibrinkleber und Gewebekleber. Einige Evidenz basierend auf randomisierten Studien über den Einsatz von Fibrinkleber allein oder in Verbindung mit Kollagenvlies ist vorhanden. Systemische Blutstillung kann erreicht werden durch Lysinanaloga, wie ε-Aminokapronsäure oder Tranexamsäure, sowie Aprotinin, beides Inhibitoren der Fibrinolyse. Es besteht reichlich Evidenz aus randomisierten kontrollierten Studien über den Gebrauch dieser Substanzen in der Chirurgie, manchmal sind diese jedoch widersprüchlich. Jüngst wurde die Rolle des rekombinanten aktivierten Faktor VII zur Blutstillung untersucht.

Abstract

Surgery inevitably leads to bleeding, and hemostasis aims at reducing the amount of blood loss and the need for transfusion as well as preventing rebleeding, hematoma formation, and the need for repeat surgery. Various locally applicable agents are in use including bone wax, gelatin, collagen, oxidized regenerated cellulose, fibrin sealant glues, and synthetic glues. Some evidence from randomized controlled trials (RCT) exists regarding the use of fibrin sealants on their own or combined with collagen fleece. Systemic hemostasis may be achieved with lysine analogs such as epsilon-aminocaproic acid or tranexamic acid and aprotinin, which are inhibitors of fibrinolysis. There is much albeit sometimes conflicting evidence from RCT regarding the use of these substances in surgery. The role of recombinant activated factor VII in achieving systemic hemostasis is being investigated.

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Literatur

  1. Arnold DM, Fergusson DA, Chan AKC et al. (2006) Avoided Transfusions in Children Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Trials of Aprotinin. Anesth Analg 102: 731

    Article  PubMed  Google Scholar 

  2. Barret JP, Dziewulski P, Wolf SE et al. (1999) Effect of topical and sucutaneous epinephrine in combination with topical thrombin in blood loss during immediate near-total burn wound excision in pediatric burned patients. Burns 25: 509

    Article  PubMed  Google Scholar 

  3. Camasara MA, Ollé G, Serra-Prat M et al. (2006) Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 96: 576

    Article  PubMed  Google Scholar 

  4. Canonico S, Sciaudone G, Pacifico F, Antoriello A (1999) Inguinal hernia repair in patients with coagulation problems: Prevention of postoperative bleeding with human fibrin glue. Surgery 125: 315

    PubMed  Google Scholar 

  5. Carless PA, Anthony DM, Henry DA (2002) Systematic review of the use of fibrin sealant to minimize perioperative alogeneic blood transfusion. Br J Surg 89: 695

    Article  PubMed  Google Scholar 

  6. Casbard AC, Williamson LM, Murphy MF et al. (2004) The role of prophylactic fresh frozen plasma in decreasing blood loss and correcting coagulopathy in cardiac surgery. A systemic review. Anaesthesia 59: 550

    Article  PubMed  Google Scholar 

  7. Cid J, Lozano M (2005) Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthoplasty: results of a meta-analysis of randomized controlled trials. Transfusion 45: 1302

    PubMed  Google Scholar 

  8. Friederich PW, Henry CP, Messelink EJ et al. (2003) Effect of recombinant activated factor VII on perioperative blood loss in patients undergoing retropubic prostatectomy: a double-blind placebo-controlled randomized trial. Lancet 361:201

    Article  PubMed  Google Scholar 

  9. Frilling A, Stavrou GA, Mischinger H-J et al. (2005) Effectiveness of a new carrier-bound fibrin sealant versus argon beamer as haemostatic agent during liver resection: a randomised prospective trial. Langenbecks Arch Surg 390: 114

    Article  PubMed  Google Scholar 

  10. Haas S (2006) The use of surgical patch coated with human coagulation factors in surgical routine: a multicenter postauthorization surveillance. Clin Appl Thromb Hemost 12: 445

    PubMed  Google Scholar 

  11. Ho KM, Ismail H (2003) Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care 31: 529

    PubMed  Google Scholar 

  12. Ickx BE, van der Linden PJ, Melot C et al. (2006) Comparison of the effects of aprotinin and tranexamic acid on blood loss and red blood cell transfusion requirements during the late stages of liver transplantation. Transfusion 46: 595

    Article  PubMed  Google Scholar 

  13. Isgro F, Stanisch O, Kiessling A-H et al. (2002) Topical application of aprotinin in cardiac surgery. Perfusion 17: 347

    Article  PubMed  Google Scholar 

  14. Kikura M, Levy JH, Tanaka KA JG (2006) A double –blind, placebo-controlled trial of epsilon-aminocaproic acid for reducing blood loss in coronary artery bypass grafting surgery. J Am Coll Surg 202:216–222

    Article  PubMed  Google Scholar 

  15. Leijdekkers VJ, Vahl AC, Mackaay AJC et al. (2006) Aprotinin Does Not Diminish Blood Loss in Elective Operations for Infrarenal Abdominal Aneurysms: A Randomized Double-Blind Controlled Trial. Ann Vasc Surg 20: 322

    Article  PubMed  Google Scholar 

  16. Levi M, Cromheecke E, de Jonge E et al. (1999) Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 354: 1940

    Article  PubMed  Google Scholar 

  17. Levy O, Martinowitz U, Oran A et al. (1999) The Use of Fibrin Tissue Adhesive to Reduce Blood Loss and the Need for Blood Transfusion after Total Knee Arthroplasty: A Prospective, Randomized, Multicenter Study. J Bone Joint Surg Am: 81: 1580

  18. Lodge JPA, Jonas S, Oussoultzoglou E et al. (2005) Recombinant Coagulation Factor VIIa in Major Liver Resection. Anesthesiology 102: 269

    Article  PubMed  Google Scholar 

  19. Mahdy AM, Webster NR (2004) Perioperative systemic haemostatic agents. Br J Anaesth 93: 842

    Article  PubMed  Google Scholar 

  20. Munoz JJ, Birkmeyer NJ, Birkmeyer JD et al. (1999) Is epsilon-aminocaproic acid as effective als aprotinin in reducing bleeding with cardiac surgery?: a meta-analysis. Circulation 99: 81

    PubMed  Google Scholar 

  21. Murphy GJ, Mango E, Lucchetti V et al. (2006) A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 132: 475

    Article  PubMed  Google Scholar 

  22. Nisar A, Shabbir J, Tubassam MA et al. (2006) Local anaesthetic flush reduces postoperative pain and haematoma formation after great saphenous vein stripping –a randomised controlled trial. Eur J Vasc Endovasc Surg 31: 325

    Article  PubMed  Google Scholar 

  23. Porte RJ, Molenaar IQ, Begliomini et al. (2000) Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomized double-blind study. EMSALT study group. Lancet 355:1303

    Article  PubMed  Google Scholar 

  24. Schonauer C, Tessitore E, Barbagallo G et al. (2004) The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Eur Spine J 13: 89

    Article  Google Scholar 

  25. Schwartz M, Madariaga J, Hirose R et al. (2004) Comparison of a New Fibrin Sealant With Standard Topical Hemostatic Agents. Arch Surg 139: 1148

    Article  PubMed  Google Scholar 

  26. Shao Y-F, Yang J-M, Chau G-Y et al. (2004) Safety and hemostatic effect of recombinant activated factor VII in cirrhotic patients undergoing partial hepatectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Am J Surg 191: 245

    Article  Google Scholar 

  27. Shiga T, Wajima Z, Inoue T, Sakamoto A (2005) Aprotinin in Major Orthopedic Surgery: A Systematic Review of Randomized Controlled Trials. Anaesth Analg 101: 1602

    Article  Google Scholar 

  28. Sintler MP, Mahmood A, Smith SR et al. (2005) Randomized trial comparing Quixil surgical sealant with Kaltostat hemostatic dressing to control suture line bleeding after carotid endarterectomy with ePTFE patch reconstruction. World J Surg 29: 1259

    Article  PubMed  Google Scholar 

  29. Wang W-D, Liang L-J, Huang X-Q, Yin X-Y (2006) Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol 12: 935

    PubMed  Google Scholar 

  30. Wu C-C, Ho W-M, Cheng S-B et al. (2006) Perioperative Parenteral Tranexamic Acid in Liver Tumor Resection. A Prospective Randomized Trial Toward a „Blood Transfusion“-Free Hepatectomy. Ann Surg 243: 173

    Article  PubMed  Google Scholar 

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

    W.O. Bechstein & C. Strey

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  1. W.O. Bechstein
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  2. C. Strey
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Correspondence to W.O. Bechstein.

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Bechstein, W., Strey, C. Möglichkeiten der lokalen und systemischen Blutstillung bei chirurgischen Eingriffen. Chirurg 78, 95–100 (2007). https://doi.org/10.1007/s00104-006-1289-x

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  • DOI: https://doi.org/10.1007/s00104-006-1289-x

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