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Phlebologie 2016; 45(04): 215-218
DOI: 10.12687/phleb2315-4-2016
Review article
Schattauer GmbH

Venöse Thromboembolie im Alter

Article in several languages: English | deutsch
C. Ploenes
1   Dominikus-Krankenhaus Düsseldorf, Düsseldorf/Germany
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Publication History

Received: 08 June 2016

Accepted: 10 June 2016

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Alter ist ein unabhängiger Risikofaktor der venösen Thromboembolie. Die Symptomatik wird bei betagten und geriatrischen Patienten oft als Ausdruck der bestehenden, insbesondere kardiopulmonalen Komorbidität gedeutet. Wenn man aber die Möglichkeit einer venösen Thromboembolie (VTE) ins Auge fasst, deutet die Synopse der bestehenden Beschwerden und anamnestischen Informationen (systematisch evaluiert z.B. im Wells-Score) oft dennoch auf die Diagnose. Die sekundärprophylaktische Behandlung besteht in der therapeutischen Antikoagulation durch Vitamin-K-Antagonisten oder orale, direkt wirksame Antikoagulanzien (DOAK). In beiden Fällen ist strikte Compliance des Patienten oder des Betreuenden essenziell. Ein Hauptaugenmerk ist zu richten auf ein im Alter deutlich gesteigertes Blutungsrisiko durch die gleichzeitige Einnahme von Thrombozytenaggregationshemmern oder nicht-steroidaler Antirheumatika, oft auch durch unbekannte Eigenmedikation. Bei Notwendigkeit einer langfristigen Antikoagulationstherapie kann die Strategie einer dosisgeminderten Fortführung erwogen werden, insbesondere bei gesteigertem Blutungsrisiko.

Eine systemische Fibrinolyse bei Lungenembolie geht bei betagten Patienten mit einem sehr hohen Blutungsrisiko einher. Sie sollte lediglich bei Kreislaufdepression mit vitaler Indikation, nicht aber bei isolierten Zeichen der Rechtsherzbelastung erfolgen.

Schlüsselwörter

Venöse Thomboembolie - Alter - geriatrischer Patient - orale Antikoagulation
 

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