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Antikoagulation in der Dermatologie

Dermatologic asepcts of anticoagulation

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Zusammenfassung

Das Gerinnungssystem schützt den Körper über komplex regulierte Prozesse vor unkontrollierten Blutverlusten. Im Falle einer Verletzung schaltet das Gerinnungssystem in Bruchteilen von Sekunden von kontrolliertem Blutfluss auf akute Gerinnung und Thrombusbildung mit dem Ziel der Blutflussstillung um. Nur geringe Verschiebungen der ausgewogenen Balance zwischen Gerinnung und freiem Blutfluss machen den Unterschied zwischen unkontrolliertem Blutverlust und ggf. fatalen thrombembolischen Ereignissen aus. Eine iatrogene Beeinflussung dieses Systems ist durch eine Vielzahl an Therapeutika möglich. Der vorliegende Beitrag möchte dem klinisch tätigen Dermatologen die Grundzüge der Gerinnung auffrischend darstellen und eine Hilfestellung nicht nur auf dem Gebiet der Thromboseprophylaxe geben, sondern auch weitere Anwendungsbereiche von therapeutisch genutzten Antikoagulanzien aufzeigen.

Abstract

The coagulation system protects the body from uncontrolled blood loss by means of highly regulated processes. In case of an injury the coagulation system instantly switches from controlled blood flow to acute coagulation and thrombus formation with the goal of stopping the blood loss. Minor changes in this well-maintained equilibrium of coagulation and blood flow tip the balance towards uncontrolled blood loss or even fatal thromboembolic events. Iatrogenic manipulation of this highly regulated system is possible with a variety of therapeutic agents. We review the basics of coagulation physiology and then discuss dermatologically relevant aspects of thrombosis prevention, as well as the use of anticoagulants to treat dermatologic diseases.

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Literatur

  1. Bergmeier W, Piffath CL, Goerge T et al (2006) The role of platelet adhesion receptor GPIbalpha far exceeds that of its main ligand, von Willebrand factor, in arterial thrombosis. Proc Natl Acad Sci U S A 103(45):16900–16905

    Article  CAS  PubMed  Google Scholar 

  2. Chauhan AK, Goerge T, Schneider SW, Wagner DD (2007) Formation of platelet strings and microthrombi in the presence of ADAMTS-13 inhibitor does not require P-selectin or beta3 integrin. J Thromb Haemost 5(3):583–589

    Article  CAS  PubMed  Google Scholar 

  3. Schneider SW, Nuschele S, Wixforth A et al (2007) Shear-induced unfolding triggers adhesion of von Willebrand factor fibers. Proc Natl Acad Sci U S A 104(19):7899–7903

    Article  CAS  PubMed  Google Scholar 

  4. Arnout J, Hoylaerts MF, Lijnen HR (2006) Haemostasis. Handb Exp Pharmacol 176 Pt 2:1–41

    Article  Google Scholar 

  5. Butenas S, ‚t Veer C van, Mann KG (1997) Evaluation of the initiation phase of blood coagulation using ultrasensitive assays for serine proteases. J Biol Chem 22;272(34):21527–21533

  6. Kasthuri RS, Taubman MB, Mackman N (2009) Role of tissue factor in cancer. J Clin Oncol 27(29):4834–4838

    Article  CAS  PubMed  Google Scholar 

  7. Tang H, Ivanciu L, Popescu N et al (2007) Sepsis-induced coagulation in the baboon lung is associated with decreased tissue factor pathway inhibitor. Am J Pathol 171(3):1066–1077

    Article  CAS  PubMed  Google Scholar 

  8. Deutsche Gesellschaft für Chirurgie et al (o J) AWMF Leitlinie „Prophylaxe der venösen Thromboembolie“ (VTE) [Internet]

  9. Zaghdoudi I, Rezgui M, Zouaoui W et al (2008) Incidence of deep venous thrombosis in patients with erysipelas of the leg: Prospective study of 30 cases in an emergency department. Pathophysiol Haemost Thromb 36(5):271–274

    Article  PubMed  Google Scholar 

  10. Perrot JL, Perrot S, Laporte Simitsidis S (2001) Is anticoagulant therapy useful when treating erysipelas? Ann Dermatol Venereol 128(3 Pt 2):352–357

    CAS  PubMed  Google Scholar 

  11. Falanga A, Zacharski L (2005) Deep vein thrombosis in cancer: The scale of the problem and approaches to management. Ann Oncol 16(5):696–701

    Article  CAS  PubMed  Google Scholar 

  12. Grazziotin MU, Turnipseed WD (2002) Arterial tumor embolism caused by metastatic melanoma: case report and literature review. J Vasc Surg 36(1):191–193

    Article  PubMed  Google Scholar 

  13. Machnick S, Butz T, Bracht M van et al (2009) Multiple cardiac metastases from a malignant melanoma causing consecutive pulmonary embolism. Herz 34(5):410–411

    PubMed  Google Scholar 

  14. Valente M, Pozzi-Mucelli F, Ponte E (2001) Venous thromboembolism and melanoma. Minerva Cardioangiol 49(5):327–333

    CAS  PubMed  Google Scholar 

  15. Arbeit JM, Lowry SF, Line BR et al (1981) Deep venous thromboembolism in patients undergoing inguinal lymph node dissection for melanoma. Ann Surg 194(5):648–655

    Article  CAS  PubMed  Google Scholar 

  16. Görge T, Schneider SW (2008) Tumor-induzierte Thrombophilie. Zellbiologische Grundlagen und klinischer Ausblick. Phlebologie 36(3):142–147

    Google Scholar 

  17. Barret JP, Dziewulski PG (2006) Complications of the hypercoagulable status in burn injury. Burns 32(8):1005–1008

    Article  PubMed  Google Scholar 

  18. Jung M, Kippes W, Messer G et al (1999) Increased risk of bullous pemphigoid in male and very old patients: a population-based study on incidence. J Am Acad Dermatol 41(2 Pt 1):266–268

    Article  CAS  PubMed  Google Scholar 

  19. Hussain SK, Sundquist J, Hemminki K (2010) Incidence trends of squamous cell and rare skin cancers in the swedish national cancer registry point to calendar year and age-dependent increases. J Invest Dermatol (in press)

  20. Gohel MS, Taylor M, Earnshaw JJ et al (2005) Risk factors for delayed healing and recurrence of chronic venous leg ulcers – an analysis of 1324 legs. Eur J Vasc Endovasc Surg 29(1):74–77

    Article  CAS  PubMed  Google Scholar 

  21. Sommer F, Hensen P, Bockenholt B et al (2007) Underlying diseases and co-factors in patients with severe chronic pruritus: a 3-year retrospective study. Acta Derm Venereol 87(6):510–516

    Article  PubMed  Google Scholar 

  22. Stinnett JM, Pendleton R, Skordos L et al (2005) Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates. Am J Hematol 78(3):167–172

    Article  PubMed  Google Scholar 

  23. Sunderkotter C, Groot K de (2008) Therapy of vasculitides and vasculopathies. Hautarzt 59(5):382–393

    Article  CAS  PubMed  Google Scholar 

  24. Maguiness S, Guenther L (2002) Kasabach-Merritt syndrome. J Cutan Med Surg 6(4):335–339

    Article  PubMed  Google Scholar 

  25. Auletta MJ, Headington JT (1988) Purpura fulminans. A cutaneous manifestation of severe protein C deficiency. Arch Dermatol 124(9):1387–1391

    Article  CAS  PubMed  Google Scholar 

  26. Fujikawa K, Suzuki H, McMullen B, Chung D (2001) Purification of human von Willebrand factor-cleaving protease and its identification as a new member of the metalloproteinase family. Blood 98(6):1662–1666

    Article  CAS  PubMed  Google Scholar 

  27. Deutsche Gesellschaft für Angiologie und weitere AWMF-Mitgliedsgesellschaften (o J). Diagnostik und Therapie der Bein- und Beckenvenenthrombose und Lungenembolie. [Internet]. 01/2005

  28. Mueller RL (2004) First-generation agents: Aspirin, heparin and coumarins. Best Pract Res Clin Haematol 17(1):23–53

    Article  CAS  PubMed  Google Scholar 

  29. McCarter JC, Bingham JB, Meyer OO (1944) Studies on the hemorrhagic agent 3,3’-methylenebis (4-hydroxycoumarin): IV. the pathologic findings after the administration of dicumarol. Am J Pathol 20(3):651–659

    CAS  PubMed  Google Scholar 

  30. Best CH (1959) Preparation of heparin and its use in the first clinical cases. Circulation 19(1):79–86

    CAS  PubMed  Google Scholar 

  31. Hirsh J (1991) Heparin. N Engl J Med 324(22):1565–1574

    Article  CAS  PubMed  Google Scholar 

  32. Fabris F, Luzzatto G, Stefani PM et al (2000) Heparin-induced thrombocytopenia. Haematologica 85(1):72–81

    CAS  PubMed  Google Scholar 

  33. Kishimoto TK, Viswanathan K, Ganguly T et al (2008) Contaminated heparin associated with adverse clinical events and activation of the contact system. N Engl J Med 358(23):2457–2467

    Article  CAS  PubMed  Google Scholar 

  34. Mammen EF (1999) Low molecular weight heparins and heparin-induced thrombocytopenia. Clin Appl Thromb Hemost 5(Suppl 1):S72–S75

    Article  PubMed  Google Scholar 

  35. Levine M, Gent M, Hirsh J et al (1996) A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 334(11):677–681

    Article  CAS  PubMed  Google Scholar 

  36. Schmid P, Fischer AG, Wuillemin WA (2009) Low-molecular-weight heparin in patients with renal insufficiency. Swiss Med Wkly 139(31–32):438–452

    Google Scholar 

  37. Schinzel H (2007) Einsatz von niedermolekularen Heparinen bei Niereninsuffizienz. Vascular Care 01/2007:4–17

    Google Scholar 

  38. Lim W (2010) Using low molecular weight heparin in special patient populations. J Thromb Thrombolysis 29(2):233–240

    Article  CAS  PubMed  Google Scholar 

  39. Dager WE, Andersen J, Nutescu E (2004) Special considerations with fondaparinux therapy: heparin-induced thrombocytopenia and wound healing. Pharmacotherapy 24(7 Pt 2):88S–94S

    Article  CAS  PubMed  Google Scholar 

  40. Perzborn E, Roehrig S, Straub A et al (2010) Rivaroxaban: a new oral factor xa inhibitor. Arterioscler Thromb Vasc Biol 30(3):376–381

    Article  CAS  PubMed  Google Scholar 

  41. Schumacher WA, Luettgen JM, Quan ML, Seiffert DA (2010) Inhibition of factor XIa as a new approach to anticoagulation. Arterioscler Thromb Vasc Biol 30(3):388–392

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Münster, von Esmarchstr. 58, 48149, Münster, Deutschland

    V. Meyer &  T. Görge

  2. Klinik und Poliklinik für Dermatologie, Venereologie und Allergologie, Experimentale Dermatologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Mannheim, Deutschland

    S.W. Schneider

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  1. V. Meyer
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Correspondence to T. Görge.

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Meyer, V., Schneider, S. & Görge, T. Antikoagulation in der Dermatologie. Hautarzt 61, 705–718 (2010). https://doi.org/10.1007/s00105-010-1996-6

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