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Heparin-induzierte Thrombozytopenie

  • A. Greinacher

Zusammenfassung

Seit Beginn der therapeutischen Anwendung von Heparin werden Thrombozytopenien unter der Heparingabe beobachtet. Aufgrund der weiten Verbreitung des Heparins zur Prophylaxe und Therapie thromboembolischer Komplikationen gilt die Heparin-induzierte Thrombozytopenie (HIT) zur Zeit als häufigste medikamenteninduzierte Thrombozytopenie.

Die biochemischen und gerinnungsphysiologischen Eigenschaften von Heparin, niedermolekularen (LMW-)Heparinen, Heparanen, Glykosami-noglykanen und Heparinoiden werden an anderer Stelle dieses Buches dargestellt.

Die HIT unterscheidet sich von allen anderen medikamenteninduzierten Thrombozytopenien durch ihren klinischen Verlauf, da sie mit schwerwiegenden arteriellen und venösen throm-boembolischen Gefäßverschlüssen einhergehen kann. Bei der HIT werden 2 Formen unterschieden und als Typ I und Typ II bezeichnet. Der Typ I hat nichtimmunologische, der Typ II immunologische Ursachen. Im folgenden werden im Abschnitt HIT Typ I die nichtimmunologischen Wechselwirkungen zwischen Heparin und Thrombozyten zusammengefaßt. Zur HIT Typ II werden neben den klinischen Kriterien und dem bisherigen Wissen zur Pathophysiologie der HIT die verschiedenen Möglichkeiten der Diagnosesicherung dargestellt und daraus Möglichkeiten der Therapie und Prophylaxe der HIT entwickelt.

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© Springer-Verlag Berlin Heidelberg 1999

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  • A. Greinacher

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