Behandlung der tiefen Venenthrombose

Zusammenfassung

Von den verschiedenen, zur Behandlung der tiefen Venenthrombose zur Verfügung stehenden Optionen, stellt die akute Antikoagulanzientherapie mit Heparinen, insbesondere niedermolekularen Heparinen, gefolgt von der frühzeitig überlappend eingeleiteten oralen Antikoagulation, das Standardvorgehen dar. Thrombolyse, Thrombektomie und Implantation von Kavaschirmfiltern kommen nur bei wenigen Patienten sinnvoll in Betracht. Während somit die medikamentöse Therapie mit Heparinen und Cumarinen die medikamentöse Standardbehandlung darstellt, sind begleitende Therapiemaßnahmen, wie die Notwendigkeit zur initialen Immobilisation der Patienten sowie zur Kompressionsbehandlung bei tiefen Venenthrombosen in ihrer Wertigkeit ungesichert und Gegenstand kontroverser Diskussionen. Darüber hinaus werden die optimale Dauer der oralen Antikoagulation, der Stellenwert einer prolongierten Therapie mit niedermolekularen Heparinen sowie der Stellenwert neuerer Antithrombotika wie Antithrombine, Faktor-Xa-Hemmstoffe und »Tissue factor pathway inhibitor« diskutiert.

Summary

The management of acute venous thrombosis is based on the initial anticoagulation with heparins – more recently low molecular weight heparins – followed by early started overlapping prolonged oral anticoagulation. Only in a few situations medical thrombolysis, thrombectomy, implantation of vena cava filters may be considered as alternative treatment strategies. Whereas anticoagulation with heparins and cumarins is the current standard the role of initial bed rest of the patients, as well as the role of external compression are discussed controversially. Furthermore the optimal duration of oral anticoagulation as well as the role of prolonged anticoagulation with low molecular weight heparins have to be defined by further investigations. In addition new anticoagulant drugs such as thrombin- or factor Xa- or tissue-factor-pathway-inhibitors may become effective in the treatment of venous thrombosis in the future.

Schlüsselwörter

Venenthrombose - Antikoagulation - Heparin - Thrombolyse - Thrombektomie - Kavaschirm - Immobilisation - Kompressionsbehandlung

Keywords

Venous Thrombosis - anticoagulation - heparin - thrombolysis - thrombectomy - caval vein filter - Immobilisation - external Compression

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