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Anästhesie bei Patienten mit Störungen der Blutgerinnung

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Die Anästhesiologie

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Zusammenfassung

Perioperative Gerinnungsstörungen können sich als Blutung (Hypokoagulabilität) oder als Thrombose bzw. Embolie (Hyperkoagulopathie) bemerkbar machen. Bei der Diagnose und Therapie von perioperativen Gerinnungsstörungen müssen die primäre Hämostase und das plasmatische Gerinnungssystem gesondert beachtet werden. Sowohl angeborene als auch erworbene Gerinnungsstörungen werden in diesem Kapitel vorgestellt.

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Literatur

  1. Ait-Oufella H, Maury E, Bartal C, Yitzhak A (2009) The role of thromboelastometry and recombinant factor VIIa in trauma. Curr Opin Anaesthesiol 22:281–288

    Article  Google Scholar 

  2. Antonijevic NM, Savic NB, Perunicic J et al (2006) Salvage late plasmapheresis in a patient with pulmonary embolism caused by heparin-induced thrombocytopenia primarily resistant to danaparoid sodium and lepirudin. J Clin Apher 21:252–255

    Article  PubMed  Google Scholar 

  3. Bartal C, Yitzhak A (2009) The role of thromboelastometry and recombinant factor VIIa in trauma. Curr Opin Anaesthesiol 22:281–288

    Article  PubMed  Google Scholar 

  4. Bernstein D (2000) Effectiveness of the recombinant factor VIIa in patients with the coagulopathy of advanced child’s B and C cirrhosis. Semin Thromb Hemost 26:437–438

    Article  CAS  PubMed  Google Scholar 

  5. Bershad EM, Suarez JI (2010) Prothrombin complex concentrates for oral anticoagulant therapy-related intracranial hemorrhage: a review of the literature. Neurocrit Care 12:403–413

    Article  CAS  PubMed  Google Scholar 

  6. Bhatt DL (2007) Intensifying platelet inhibition – navigating between scylla and charybdis. N Engl J Med 357:2078–2081

    Article  CAS  PubMed  Google Scholar 

  7. Boffard KD, Riou B, Warren B et al (2005) Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double blind clinical trials. J Trauma 59:8–15

    Article  CAS  PubMed  Google Scholar 

  8. Bundesärztekammer (2009) Querschnittsleitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten – Gesamtnovelle 2008. Deutscher Ärzteverlag Köln, 4. Aufl.

    Google Scholar 

  9. Colman RW, Marder VJ, Salzman EW, Hirsh J (1993) Overview of hemostasis. In: Colman RW, Marder VJ, Salzman EW, Hirsh J (Hrsg) Hemostasis and thrombosis. Lippincott, Philadelphia, S 6–8

    Google Scholar 

  10. De Lorenzo C, Calatzis A, Welsch U, Heindl B (2006) Fibrinogen concentrate reverses dilutional coagulopathy induced by in vitro saline but not by hydroxyethyl starch 6 %. Anesth Analg 102:1194–1200

    Article  PubMed  Google Scholar 

  11. Di Nisio M, Middeldorp S, Büller HR (2005) Direct thrombin inhibitors. N Engl J Med 353:1028–1040

    Article  PubMed  Google Scholar 

  12. Douketis JD, Spyropoulos AC, Kaatz S, for the BRIDGE Investigators et al (2015) Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 373:823–833

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Federici AB, Rand JH, Bucciarelli P et al (2000) Subcommittee on von Willebrand factor: acquired von Willebrand syndrome: data from an international registry. Thromb Haemost 84:345–349

    CAS  PubMed  Google Scholar 

  14. Fries D, Innerhofer P, Reif C et al (2006) The effect of fibrinogen substitution on reversal of dilutional coagulopathy: an in vitro model. Anesth Analg 102:347–351

    Article  CAS  PubMed  Google Scholar 

  15. Fries D, Martini WZ (2010) Role of fibrinogen in trauma-induced coagulopathy. Br J Anaesth 105:116–121

    Article  CAS  PubMed  Google Scholar 

  16. Giebl A, Gürtler K (2014) Neue orale Antikoagulanzien in der perioperativen Medizin. Anaesthesist 63:347–364

    Article  CAS  PubMed  Google Scholar 

  17. Görlinger K, Dirkmann D, Hanke AA et al (2011) First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 115:1179–1191

    PubMed  Google Scholar 

  18. Gulba DC, Broscaru L, Amani A (2013) Elektive Eingriffe und Notfallbehandlung unter Antikoagulation – Strategien zur Optimierung bestehender Risiken. Klinikarzt 42(S1):34–39

    Google Scholar 

  19. Guth MC, Kaufner L, Kleber C, von Heymann C (2012) Behandlung der traumainduzierten Koagulopathie – Was ist die Evidenz? Anasthesiol Intensivmed Notfallmed Schmerzther 47:528–539

    Article  PubMed  Google Scholar 

  20. Hanke AA, Dellweg C, Schöchl H et al (2011) Potential of whole blood coagulation reconstitution by desmopressin and fibrinogen under conditions of hypothermia and acidosis – an in vitro study using rotation thrombelastometry. Scand J Clin Lab Invest 71:292–298

    Article  CAS  PubMed  Google Scholar 

  21. Heim MU (2009) Die neuen Querschnittleitlinien der Bundesärztekammer – Evidenzbasierte Empfehlungen für die Risiko-Nutzen-Abwägung bei der Hämotherapie. AINS Anästhesiol Intensivmed Notfallmed Schmerzther 44:186–199

    PubMed  Google Scholar 

  22. Heindl B, Delorenzo C, Spannagl M (2005) Hochdosierte Fibrinogengabe zur Akuttherapie von Gerinnungsstörungen bei perioperativer Massivtransfusion. Anaesthesist 54:787–790

    Article  CAS  PubMed  Google Scholar 

  23. Himmelreich G, Riess H (1993) Pathophysiologie und Therapie der Verbrauchskoagulopathie. Klin Lab 39:25–30

    CAS  Google Scholar 

  24. Innerhofer P, Westermann I, Tauber H et al (2013) The exclusive use of coagulation factor concentrates enables reversal of coagulopathy and decreases transfusion rates in patients with major blunt trauma. Injury 44:209–216

    Article  PubMed  Google Scholar 

  25. Innerhofer P, Streif W, Kühbacher G, Fries D (2004) Monitoring der perioperativen Dilutionskoagulopathie mittels ROTEM-Analyzer – Grundlagen und klinische Beispiele. AINS Anästhesiol Intensivmed Notfallmed Schmerzther 39:739–744

    CAS  PubMed  Google Scholar 

  26. James S, Akerblom A, Cannon CP et al (2009) Comparison of ticagrelor, the first reversible oral P2Y(12) receptor antagonist, with clopidogrel in patients with acute coronary syndromes: rationale, design, and baseline characteristics of the PLATelet inhibition and patient Outcomes (PLATO) trial. Am Heart J 57:599–605

    Article  Google Scholar 

  27. James AH, Manco-Johnson MJ, Yawn BP, Dietrich JE, Nichols WL (2008) Von Willebrand disease: key points from the 2008 national heart, lung, and blood institute guidelines. Obstet Gynecol 114:674–678

    Article  Google Scholar 

  28. Keser C (2000) Thrombozytenaggregationshemmer bei Spinalanästhesie. Leserfragen Anästhesist 49:234–235

    Article  CAS  Google Scholar 

  29. Kim TH, Kim JY, Mun HS et al (2015) Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non-valvular atrial fibrillation patients: a multicenter propensity-matched analysis. J Thromb Haemost 13:182–190

    Article  CAS  PubMed  Google Scholar 

  30. Kozek-Langenecker SA, Afshari A, Albaladejo P et al (2013) Management of severe perioperative bleeding: guidelines from the European society of anaesthesiology. Eur J Anaesthesiol 30:270–382

    Article  PubMed  Google Scholar 

  31. Lancé M, Stessel B, Hamulyák K, Marcus MA (2010) Alte und neue Gerinnungshemmer. Anästhesist 59:62–68

    Article  Google Scholar 

  32. Lehoux S, Guidet B, Offenstadt G (2010) The endothelium: physiological functions and role in microcirculatory failure during severe sepsis. Intensive Care Med 36:1286–1298

    Article  PubMed  Google Scholar 

  33. Lier H, Krep H, Schöchl H (2009) Gerinnungsmanagement bei der Polytraumaversorgung. Anaesthesist 58:1010–1026

    Article  CAS  PubMed  Google Scholar 

  34. Masud F, Bostan F, Chi E et al (2009) Recombinant factor VIIa treatment of severe bleeding in cardiac surgery patients: a retrospective analysis of dosing, efficacy, and safety outcomes. J Cardiothorac Vasc Anesth 23:28–33

    Article  PubMed  Google Scholar 

  35. Menitove JE (1991) Preparation and clinical use of plasma and plasma fractions. In: Williams WJ, Beutler E, Erslev AJ, Lichtman MA (Hrsg) Hematology. McGraw Hill, New York, S 659–673

    Google Scholar 

  36. Middelburg RA, van de Watering LM, van der Bom JG (2010) Blood transfusions: good or bad? Confounding by indication, an underestimated problem in clinical transfusion research. Transfusion 50:1181–1183

    Article  PubMed  Google Scholar 

  37. Mitra B, Mori A, Cameron PA et al (2010) Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation. Injury 41:35–39

    Article  PubMed  Google Scholar 

  38. Nowak G (2009) Heparin-induced thrombocytopenia (HIT II) – a drug-associated autoimmune disease. Thromb Haemost 102:887–891

    CAS  PubMed  Google Scholar 

  39. Nowak-Göttl U, Langer F, Limperger V, Mesters R, Trappe RU (2014) Bridging: Perioperatives Vorgehen bei dauerhafter oraler Antikoagulation oder Plättchenfunktionshemmung. Dtsch Med Wochenschr 139:1301–1306

    Article  PubMed  Google Scholar 

  40. Peiniger S, Nienaber U, Lefering R et al (2011) Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie. Balanced massive transfusion ratios in multiple injury patients with traumatic brain injury. Crit Care 15:R68

    Article  PubMed  PubMed Central  Google Scholar 

  41. Pfanner G, Koscielny J, Pernerstorfer T et al (2007) Präoperative Blutungsanamnese. Anaesthesist 56:604–611

    Article  CAS  PubMed  Google Scholar 

  42. Rahe-Meyer N, Solomon C, Hanke A et al (2013) Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial. Anesthesiology 118:40–50

    Article  CAS  PubMed  Google Scholar 

  43. Rossaint R, Bouillon B, Cerny V et al (2010) Management of bleeding following major trauma: an updated European guideline. Crit Care 14:R52

    Article  PubMed  PubMed Central  Google Scholar 

  44. Scharrer I (2005) Gerinnungsaktive Therapeutika: Antithrombin, FFP, PPSB, FXIII, rFVIIa. Haemostaseologie 25:209–212

    CAS  Google Scholar 

  45. Scherer R, Pulletz S, Ziemer S, Peters J (2001) Antithrombin (AT) – Wirkung: Experimentelle und klinische Ergebnisse. AINS Anästhesiol Intensivmed Notfallmed Schmerzther 36:628–639

    CAS  PubMed  Google Scholar 

  46. Scherer R, Giebler R (2004) Perioperative Gerinnungsstörungen. AINS Anästhesiol Intensivmed Notfallmed Schmerzther 39:415–446

    CAS  PubMed  Google Scholar 

  47. Schöchl H, Nienaber U, Maegele M et al (2011) Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Care 15:R83

    Article  PubMed  PubMed Central  Google Scholar 

  48. Spahn D, Ganter MT (2010) Towards early individual goal-directed coagulation management in trauma patients. BJA 105:103–105

    Article  CAS  PubMed  Google Scholar 

  49. Stanworth SJ, Brunskill SJ, Hyde CJ, McClelland DB, Murphy MF (2004) Is fresh frozen plasma clinically effective? A systematic review of controlled randomized trials. Br J Haematol 126:139–152

    Article  CAS  PubMed  Google Scholar 

  50. Sucker C, Michiels JJ, Zotz RB (2009) Causes, etiology and diagnosis of acquired von Willebrand disease: a prospective diagnostic workup to establish the most effective therapeutic strategies. Acta Haematol 121:177–182

    Article  CAS  PubMed  Google Scholar 

  51. Taylor FB, Emerson TE, Jordan R (1988) AT III prevents the lethal effects of Escherichia coli infusion in baboons. Circ Shock 26:227–235

    CAS  PubMed  Google Scholar 

  52. Toh CH, Dennis M (2003) Current clinical practice. DIC 2002: a review of disseminated intravascular coagulation. Hematology 8:65–71

    Article  CAS  PubMed  Google Scholar 

  53. Tripodi A, Primignani M, Lemma L et al (2010) Detection of the imbalance of procoagulant versus anticoagulant factors in cirrhosis by a simple laboratory method. Hepatology 52:249–255

    Article  CAS  PubMed  Google Scholar 

  54. Van’t Veer C, Mann KG (2000) The regulation of the factor VII-dependent coagulation pathway: rationale for the effectiveness of recombinant factor VIIa in refractory bleeding disorders. Semin Thromb Hemost 26:367–372

    Article  Google Scholar 

  55. Waurick K, Riess H, van Aken H, Kessler P, Gogarten W, Volk T (2014) S1-Leitlinie Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anästhesiol Intensivmed 55:464–492

    Google Scholar 

  56. Weber CF, Görlinger K, Meininger D et al (2012) Point-of-care testing. A prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 117:531–547

    Article  PubMed  Google Scholar 

  57. Wiviott SD, Braunwald E, McCabe CH et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes (TRITON-TIMI 38). N Engl J Med 357:2001–2015

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Ralf Scherer .

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Scherer, R. (2016). Anästhesie bei Patienten mit Störungen der Blutgerinnung. In: Rossaint, R., Werner, C., Zwißler, B. (eds) Die Anästhesiologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45539-5_109-1

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  • DOI: https://doi.org/10.1007/978-3-662-45539-5_109-1

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