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Der Klinikarzt 2012; 41(9): 412-415
DOI: 10.1055/s-0032-1329583
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© Georg Thieme Verlag Stuttgart · New York

Update Hämostaseologie – Welche Therapie, wann und für wen?

Update haemostaseology – Which therapy, when and of whom?
Robert Klamroth
1   Vivantes Klinikum im Friedrichshain, Klinik für Innere Medizin – Angiologie, Hämostaseologie und Pneumologie, Berlin
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Publication History

Publication Date:
08 October 2012 (online)

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Die Hämostaseologie spielt in der Diagnostik und Therapie venöser Thromboembolien eine wichtige Rolle. Durch die Fortschritte in der Hämostaseforschung konnten hereditäre und erworbene Risikofaktoren im Gerinnungssystem für venöse Thromboembolien identifiziert werden. Neben der Klärung der Ätiologie spontaner thrombotischer Ereignisse eignet sich die Thrombophiliediagnostik zur Risikostratifizierung bei bestimmten Patientengruppen, vor allem bei Frauen im gebärfähigen Alter. Ein generelles Screening bei allen Patienten ist nicht zu empfehlen. Die langfristige Therapie venöser Thromboembolien erfolgt auch heute noch mit Vitamin K-Antagonisten, verbunden mit einem relevanten Blutungsrisiko. Zur Therapie der Überdosierung und der Blutungskomplikationen haben sich abgestufte Therapiekonzepte zur Antagonisierung etabliert. Neue orale Medikamente zur langfristigen Gerinnungshemmung, wie der direkte Faktor-Xa-Inhibitor Rivaroxaban und der direkte Faktor-IIa-Inhibitor Dabigatran, werden zunehmend eingesetzt. Dabei sind Kenntnisse der Hämostase zur Überwachung und der Behandlung von Blutungskomplikationen unter diesen neuen Medikamenten notwendig.

The coagulation system plays an important role in diagnosis and treatment of venous thromboembolism. Several hereditary and acquired risk factors for venous thromboembolism were identified in the coagulation pathway. Besides the investigation of the underlying cause for spontaneous venous thromboembolism thrombophilia screening might be useful in the risk stratification for special patient groups like women of childbearing age. Thrombophilia screening for all patients is not recommended. The long lasting treatment of patients with venous thromboembolism is done with vitamin K antagonists with a relevant bleeding risk. Therapeutic concepts for the reversal of vitamin K antagonists are well established. New oral anticoagulants like the direct factor Xa antagonist Rivaroxaban and the direct factor IIa antagonist Dabigatran will be used widely in the future. Knowledge about the coagulation system for monitoring and the treatment of bleeding complications is necessary.

Key words

Thrombophilia screening - vitamin K antagonists - venous thromboembolism - new oral anticoagulants - bleeding complications
 

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