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Disseminierte intravasale Gerinnung

Disseminated intravascular coagulation

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Intensivmedizin und Notfallmedizin

Summary

Disseminated intravascular coagulation (DIC) is a clinical condition associated with non-localized coagualtion activation and fibrin formation in the flowing blood. DIC is triggered by a variety of diseases, including sepsis, trauma, cellular necrosis, vascular malformations, malignancies, or inflow of thromboplastic material. Patients with DIC display increased mortality and a more severe clinical course with a higher rate of organ dysfunction, compared to patients with the same disease without DIC. Sepsisinduced purpura fulminans is typically caused by meningococcal and pneumococcal infections and is associated with microvascular thrombosis in the skin and various organs. Protein C levels are very low in patients with purpura fulminans. Therefore, either recombinant activated protein C or protein C concentrate are used therapeutically. In other cases of DIC not associated with purpura fulminans, bleeding is the dominant clinical feature. These patients are treated with platelet concentrates, fresh frozen plasma, fibrinogen concentrate and various other coagulation factor preprarations. In cases of severe diffuse hemorrhage, recombinant factor VIIa is used. Antithrombin concentrate is used in patients treated with heparin for extracorporal circulation procedures and patients with macrovascular thrombosis, if low antithrombin levels or ‘heparin resistance’ are found.

Zusammenfassung

Disseminierte intravasale Gerinnung (DIG) ist ein klinischer Zustand mit nicht-lokalisierter Gerinnungsaktivierung und Fibrinbildung im fließenden Blut. Auslöser können verschiedene Kranheitsbilder, beispielsweise Sepsis, Trauma, Zellzerfall, vaskuläre Malformationen, malignen Erkrankungen, oder Einschwemmung von thromboplastischem Material sein. Patienten mit DIG zeigen im Vergleich zu Patienten mit der gleichen Grunderkrankung ohne DIG eine verringerte Überlebensrate und eine höhere Rate von Organdysfunktionen und anderen klinischen Komplikationen. Die Sepsis-induzierte Purpura fulminans wird unter anderem bei Patienten mit Meningokokken- und Pneumokokkeninfektionen beobachtet. Es finden sich mikrovaskuläre Thrombosen in der Haut und in den Organen, sowie eine starke Verminderung von Protein C. Therapeutisch werden rekombinantes aktiviertes Protein C oder Protein-C-Konzentrat eingesetzt. Bei anderen Patienten mit DIG ist das führende klinische Symptom die Blutung. Die Therapie umfasst Thrombocytenkonzentrate, Fibrinogenkonzentrat, Frischplasma und verschiedene Gerinnungsfaktorenkonzentrate, bei massiven diffusen Blutungen eventuell auch rekombinanten Faktor VIIa. Antithrombin-Konzentrat wird eingesetzt bei Patienten mit Heparintherapie wegen extrakorporaler Zirkulation oder makrovaskulären Thrombosen, wenn ein Antithrombin-Mangel bzw. eine Heparinresistenz festgestellt wird.

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  1. Universitätsklinikum Mannheim, I. Medizinische Klinik, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim

    C.-E. Dempfle &  M. Borggrefe

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Serie: Die Intensivtherapie bei Sepsis und Multiorganversagen Herausgegeben von L. Engelmann (Leipzig)

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Dempfle, CE., Borggrefe, M. Disseminierte intravasale Gerinnung. Intensivmed 43, 103–110 (2006). https://doi.org/10.1007/s00390-006-0595-3

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