Skip to main content
SpringerLink
Log in

Thromboseprophylaxe in unfallchirurgischen Abteilungen in Deutschland

Eine Umfrage

Thrombosis prophylaxis in trauma surgery units in Germany

A survey

  • Originalien
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

In einem Fragebogen-Survey wurden unfallchirurgische Kliniken nach ihrem Thromboseprophylaxeschema sowie zur Diagnose und Therapie der Heparin-induzierten Thrombozytopenie (HIT) befragt.

Methodik

Versand eines Fragebogens an unfallchirurgisch tätige Einrichtungen mit Fragen zu Behandlungsschwerpunkt, Verwendung unfraktionierter (UFH) und niedermolekularer Heparine (NMH), Dauer der Anwendung und HIT-Diagnostik. Die Auswertung erfolgte deskriptiv.

Ergebnisse

Von 685 verschickten Fragebögen waren 314 (46%) auswertbar: Die Hälfte stammte aus Krankenhäusern der Grund- und Regelversorgung, 96 (31%) aus Schwerpunktkliniken, 53 (17%) aus Kliniken der Maximalversorgung (übrige: 8). In >90% wurden ausschließlich NMH verwendet. Mittlere Dauer der medikamentösen Thromboseprophylaxe: 16,6±10,4 Tage (stationär/poststationär). Nur 10% hielten sich an die empfohlenen 2-täglichen Thrombozytenkontrollen (Tag 5–14) zur frühzeitigen Erkennung einer HIT.

Schlussfolgerungen

Während die medikamentöse Thromboseprophylaxe nach unfallchirurgischen Eingriffen weitgehend leitlinienkonform scheint, besteht Handlungsbedarf für eine Systematisierung der HIT-Diagnostik und Therapie.

Abstract

Background

A questionnaire study was conducted to ask trauma surgery centers about thrombosis prophylaxis methods and strategies for the diagnosis and therapy of heparin-induced thrombocytopenia (HIT).

Methods

Questionnaires were sent by post to German hospitals with trauma surgery units inquiring about the use of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH), the duration of medication, and the HIT diagnosis. Questionnaires were evaluated descriptively.

Results

314 of 685 questionnaires sent out were evaluable (46%): half were from general hospitals, 96 (31%) from specialized hospitals, and 53 (17%) from tertiary care hospitals (others: 8). In more than 90%, only LMWH was used. The mean duration of pharmacological thrombosis prophylaxis was 16.6±10.4 days (inpatient/outpatient). Only 10% adhered to the recommended platelet count controls every 2 days (days 5–14) for early detection of HIT.

Conclusions

While pharmacological thrombosis prophylaxis following trauma surgery seems to be generally performed according to guidelines, diagnosis and treatment of HIT need to be systematized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Arzneimittelkommission der deutschen Ärzteschaft (2008) Heparin-induzierte Thrombozytopenie unter Fondaparinux. Dtsch Ärztebl 105(30):A1626

    Google Scholar 

  2. Edwards P, Roberts I, Clarke M et al (2007) Methods to increase response rates to postal questionnaires. Cochrane Database Syst Rev 2:MR000008

    PubMed  Google Scholar 

  3. Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of chest physicians evidence-based clinical practice guidelines,8th edn. Chest 133(6):381–453

    Article  Google Scholar 

  4. Geerts WH, Jay RM, Code KI et al (1996) A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med 33(10):701–707

    Article  Google Scholar 

  5. Greinacher A, Lubenow N, Hinz P, Ekkernkamp A (2003) Heparininduzierte Thrombozytopenie. Dtsch Ärztebl 100(34–35):1850–1856

    Google Scholar 

  6. Handoll HH, Farrar MJ, McBirnie J et al (2002) Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev 4:CD000305

    PubMed  Google Scholar 

  7. Lubenow N, Hinz P, Thomaschewski S et al (2009) A randomised study on heparin-induced thrombocytopenia (HIT) in TRAuma Patients treated with unfractionated or low-molecular weight heparin, the HIT-TRAP trial. (Submitted)

  8. Luring C, Oczipka F, Bathis H et al (2006) Prevention of deep vein thrombosis in total knee replacement – current status of therapy in orthopedic and trauma departments in German. Sportverletz Sportschaden 20(3):149–152

    Article  CAS  PubMed  Google Scholar 

  9. Martel N, Lee J, Wells PS (2005) Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood 106(8):2710–2715

    Article  CAS  PubMed  Google Scholar 

  10. Prevention and treatment of venous thromboembolism (2006) International Consensus Statement (guidelines according to scientific evidence). Int Angiol 25(2):101–161

    Google Scholar 

  11. Schmidt LM, Foli-Andersen NJ, Rasmussen HM, Wille-Jorgensen PA (2008) Thrombo-prophylaxis in Danish surgical departments. Status 2005 and 25 years‘ development. Ugeskr Laeger 170(11):947–951

    PubMed  Google Scholar 

  12. Stationäre und ambulante Thromboembolie-Prophylaxe in der Chirurgie und der perioperativen Medizin, S2-Version 24. April 2003, AWMF online

  13. Turpie AG, Bauer KA, Eriksson BI, Lasssen 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(16):1833–1840

    Article  CAS  PubMed  Google Scholar 

  14. Warkentin TE, Greinacher A, Koster A, Lincoff AM (2008) Treatment and prevention of heparin-induced thrombocytopenia: American College of chest physicians evidence-based clinical practice guidelines, 8th edn. Chest 133(6):340–380

    Article  Google Scholar 

  15. Warkentin TE, Maurer BT, Aster R (2007) Heparin-induced thrombocytopenia associated with fondaparinux. N Engl J Med 356(25):2653–2655

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Unfall- und Wiederherstellungschirurgie, Klinikum der Ernst-Moritz-Arndt Universität, Sauerbruchstraße, 17475, Greifswald, Deutschland

    P. Hinz & A. Ekkernkamp

  2. Institut für Immunologie und Transfusionsmedizin, Klinikum der Ernst-Moritz-Arndt-Universität, Greifswald, Deutschland

    N. Lubenow, A. Wessel & A. Greinacher

Authors
  1. P. Hinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Lubenow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Wessel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Greinacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Ekkernkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Hinz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hinz, P., Lubenow, N., Wessel, A. et al. Thromboseprophylaxe in unfallchirurgischen Abteilungen in Deutschland. Unfallchirurg 112, 1029–1033 (2009). https://doi.org/10.1007/s00113-008-1557-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-008-1557-y

Schlüsselwörter

Keywords

Search

Navigation