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Adjunktive Sepsistherapie — Gerinnungsinhibitoren und anti-inflammatorische Effekte

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Diagnostik und Intensivtherapie bei Sepsis und Multiorganversagen

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In den letzten Jahren wurden die Zusammenhänge zwischen Infektion, Inflammation und Gerinnung immer besser herausgearbeitet. Dabei konnte gezeigt werden, dass die systemische Inflammation in der Sepsis auch zu einer Aktivierung des Gerinnungssystems führt; auslösende Faktoren sind in jeweils unterschiedlicher Gewichtung eine tissue-factor vermittelte Thrombinbildung, die Downregulation physiologischer gerinnungsinhibierender Prozesse und eine Blockade der Fibrinolyse. Die im Rahmen des eskalierenden Infektionsgeschehens gebildeten pro-inflammatorischen Zytokine spielen dabei eine zentrale Rolle. Andererseits konnten auch eine ganze Reihe von Mechanismen aufgezeigt werden, über die eine Gerinnungsaktivierung wiederum den inflammatorischen Prozess verstärken kann; hervorzuheben sind hier ebenso die Bildung von Thrombin oder Faktor Xa. Klinisch kann das Ausmaß der Gerinnungsstörung angefangen von leichten Veränderungen der laborchemischen Parameter bis hin zur schweren Verbrauchskoagulopathie (DIC) variieren.

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    Priv.-Doz. Dr. med. Armin Sablotzki

  2. Klinik für Anästhesiologie und Operative Intensivmedizin, Martin-Luther-Universität Halle/Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany

    Frank Nestler & Elke Czeslick

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Sablotzki, A., Nestler, F., Czeslick, E. (2006). Adjunktive Sepsistherapie — Gerinnungsinhibitoren und anti-inflammatorische Effekte. In: Engelmann, L., Schuster, HP. (eds) Diagnostik und Intensivtherapie bei Sepsis und Multiorganversagen. Steinkopff. https://doi.org/10.1007/978-3-7985-1729-5_16

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