Management von Patienten mit heparininduzierter Thrombozytopenie

Zusammenfassung

Patienten mit einer heparininduzierten Thrombozytopenie (HIT) tragen ein hohes Risiko zur Entwicklung von thromboembolischen Komplikationen. Deswegen sollte beim klinischen Verdacht einer HIT die Heparingabe beendet und gleichzeitig eine Behandlung mit alternativen Antikoagulanzien eingeleitet werden. Geeignete alternative Antikoagulanzien sind die direkten Thrombininhibitoren Hirudin, Bivalirudin und Argatroban sowie das Heparinoid Danaparoid. Darüber hinaus scheint auch das synthetische Pentasaccharid Fondaparinux geeignet zu sein. Die Entscheidung welches der alternativen Antikoagulanzien im konkreten Einzelfall eingesetzt wird, ist abhängig von der klinischen Konstellation, den pharmakokinetischen Eigenschaften und den vor Ort verfügbaren Monitoring-Möglichkeiten. Dieses Übersichtsreferat beschreibt verschiedene alternative Antikoagulationsstrategien und geht abschließend auf das langfristige Management von Patienten mit anamnestisch bekannter heparininduzierter Thrombozytopenie ein.

Summary

Heparin-induced thrombocytopenia is a strong risk factor for the development of arterial and venous thromboembolic events. In patients clinically suspected for HIT, immediate cessation of heparin treatment and continuation of anticoagulant treatment using alternative anticoagulants is mandatory in order to minimize the risk of thrombotic events. Alternative anticoagulants that have been successfully used in HIT include the direct acting thrombin inhibitors hirudin,bivalirudin and argatroban, and the heparinoid orgaran. In addition, there is growing evidence that the synthetic pentasaccharide fondaparinux is usable for the treatment of HIT patients.

This short review summarizes the strategies of alternate anticoagulant treatment in HIT patients and also describes long-term treatment of HIT patients.

Schlüsselwörter

Heparininduzierte Thrombozytopenie - Hirudin - Argatroban - Danaparoid - Fondaparinux

Keywords

Heparin-induced thrombocytopenia - hirudin - argatroban - danaparoid - fondaparinux

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