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Z Gastroenterol 2020; 58(11): 1099-1106
DOI: 10.1055/a-1246-3423
Übersicht

Gerinnungsmanagement in der gastroenterologischen Akut- und Intensivmedizin

Management of hemostasis in gastroenterology critical care
Marcus M. Mücke
1   Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
,
Wolfgang Miesbach
2   Medizinische Klinik 2, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
,
Kai-Henrik Peiffer
1   Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
,
Victoria T. Mücke
1   Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
,
Jörg Bojunga
1   Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Zusammenfassung

Neben der eigentlichen definitiven Therapie einer akuten Blutung (z. B. durch endoskopische/operative Blutstillung oder Angiografie mit Coiling) kommt in der Akut- und Intensivmedizin der Optimierung der Blutgerinnung eine Schlüsselrolle zu. Dazu ist die Kenntnis der gängigen Gerinnungstests und ihrer Schwächen ebenso notwendig wie die korrekte Anwendung und Dosierung von Gerinnungsprodukten. Das Gerinnungsmanagement kann insbesondere bei Patienten mit Leberzirrhose, angeborenen und erworbenen Gerinnungsstörungen sowie bei Patienten unter Antikoagulation herausfordernd sein. Dieses Review beleuchtet die wichtigsten Elemente der Gerinnungsdiagnostik und -therapie in der gastroenterologischen Intensiv- und Notfallmedizin inklusive neuer Antidote und erweiterter Gerinnungsdiagnostik bei Patienten mit Leberzirrhose, wie z. B. die Thrombelastometrie.

Abstract

In emergency medicine and intensive care the key to control active bleeding – besides definitive therapy (endoscopy, therapeutic angiography or operation) – often is to improve the patients clotting and thrombus formation. Knowledge about routine laboratory testing, their strength and weaknesses as well as indications and dosing of pro-coagulants and blood products remains pivotal in these situations. Achieving hemostasis can be especially challenging in patients with liver cirrhosis, innate or acquired coagulation disorders. This review summarizes the principles of hemostasis diagnostics and management in acute bleeding for gastroenterologists and hepatologists including novel available antidotes and innovative tools for patients with advanced liver disease such as thromboelastometry.

Schlüsselwörter

Blutgerinnung - Leberzirrhose - Gerinnungssubstitution - Antidote

Key words

hemostasis - liver cirrhosis - substitution - antidote


Publication History

Received: 04 May 2020

Accepted: 19 August 2020

Article published online:
16 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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