Thromboembolische Erkrankungen aus hämostaseologischer Sicht

Die Hyperkoagulabilität spielt in der Pathogenese venöser Thrombosen eine zentrale Rolle [1]. Dieser Beitrag stellt – ausgehend von der zugrunde liegenden Pathophysiologie – therapeutische Ansätze dar. Ein Schwerpunkt ist die zur Planung der Sekundärprophylaxe relevante Einschätzung des Thromboserisikos. Weiterhin werden besondere klinische Konstellationen wie das Management von Thrombosen, die trotz Antikoagulation entstanden sind, diskutiert.

Abstract

Venous thromboembolism is one of the most common vascular diseases. Increased thrombin formation together with reduced blood flow create a hypercoagulable environment that induces thrombus formation. Anticoagulants play a pivotal role in the treatment and secondary prophylaxis of venous thromboembolism because they effectively interrupt this hypercoagulability. A personalized assessment of the thrombotic risk is essential for planning the duration and intensity of secondary prophylaxis. The occurrence of thrombosis outside a typical risk situation, an atypical localization and a family history of thrombosis indicate a thrombophilic state. In these cases, thrombophilia diagnostics are useful for extended risk assessment. If anti-phospholipid antibodies are detected, the risk of recurrence is particularly increased.

Kernaussagen

• Die Hyperkoagulabilität spielt in der Pathogenese von venösen Thrombosen eine zentrale Rolle. Durch eine Antikoagulanzien-Behandlung wird die Hyperkoagulabilität effektiv unterbrochen.

• Die Abgrenzung einer sporadischen Thrombose in typischer Risikosituation von einer Spontanthrombose als Symptom eines individuell erhöhten Thromboserisikos ist für die Planung der Sekundärprophylaxe entscheidend.

• Die Thrombophilie-Diagnostik ermöglicht eine differenziertere Bewertung des individuellen Thromboserisikos.

• Die direkten oralen Antikoagulanzien ermöglichen eine sichere und effektive Therapie und Sekundärprophylaxe der venösen Thrombose.

• Patienten mit einer Thrombophilie profitieren von einer verlängerten medikamentösen Thromboseprophylaxe.

Schlüsselwörter

venöse Thromboembolie - Hyperkoagulabilität - Antikoagulation - Thromboserisiko - Sekundärprophylaxe

Keywords

venous thromboembolism - hypercoagulability - anticoagulation - thrombotic risk - secondary prophylaxis

Publikationsverlauf

Artikel online veröffentlicht:
07. Juli 2023

• Literatur

• 1 Yamashita A, Asada Y. Underlying mechanisms of thrombus formation/growth in atherothrombosis and deep vein thrombosis. Pathol Int 2023; 73: 65-80
• 2 Croles FN, Borjas-Howard J, Nasserinejad K. et al. Risk of venous thrombosis in antithrombin deficiency: a systematic review and bayesian meta-analysis. Semin Thromb Hemost 2018; 44: 315-326
• 3 Girolami A, Cosi E, Ferrari S. et al. Heparin, coumarin, protein C, antithrombin, fibrinolysis and other clotting related resistances: old and new concepts in blood coagulation. J Thromb Thrombolysis 2018; 45: 135-141
• 4 Pilia E, Belletti A, Fresilli S. et al. Efficacy and safety of heparin full-dose anticoagulation in hospitalized non-critically ill COVID-19 patients: a meta-analysis of multicenter randomized controlled trials. J Thromb Thrombolysis 2022; 54: 420-430
• 5 Bauersachs RM. Fondaparinux Sodium: Recent advances in the management of thrombosis. J Cardiovasc Pharmacol Ther 2023; 28
• 6 Hanigan S, Park JM. Evaluating pharmacokinetic drug-drug interactions of direct oral anticoagulants in patients with renal dysfunction. Expert Opin Drug Metab Toxicol 2022; 18: 189-202
• 7 Rottenstreich A, Zacks N, Kleinstern G. et al. Direct-acting oral anticoagulant drug level monitoring in clinical patient management. J Thromb Thrombolysis 2018; 45: 543-549
• 8 Parakh RS, Sabath DE. Venous thromboembolism: role of the clinical laboratory in diagnosis and management. J Appl Lab Med 2019; 3: 870-882
• 9 Ong J, Bennett A. A review of laboratory considerations in thrombophilia testing. Pathology 2022; 54: 835-841
• 10 Pengo V, Denas G. Antiphospholipid syndrome in patients with venous thromboembolism. Semin Thromb Hemost 2022;
• 11 Khairani CD, Bejjani A, Piazza G. et al. Direct oral anticoagulants vs vitamin K antagonists in patients with antiphospholipid syndromes: meta-analysis of randomized trials. J Am Coll Cardiol 2023; 81: 16-30
• 12 Akpan IJ, Stein BL. Splanchnic vein thrombosis in the myeloproliferative neoplasms. Curr Hematol Malig Rep 2018; 13: 183-190
• 13 Palareti G, Poli D, Ageno W. et al. D-dimer and reduced-dose apixaban for extended treatment after unprovoked venous thromboembolism: the Apidulcis study. Blood Adv 2022; 6: 6005-6015
• 14 Jokubaitis M, Mineikytė R, Kryžauskaitė L. et al. Testing for thrombophilia in young cryptogenic stroke patients: does the presence of patent foramen ovale make a difference?. Medicina (Kaunas) 2022; 58: 1056
• 15 Farjat-Pasos JI, Nuche J, Mesnier J. et al. Transcatheter patent foramen ovale closure in stroke patients with thrombophilia: Current status and future perspectives. J Stroke 2022; 24: 335-344
• 16 Pishko AM, Cuker A. Diagnosing heparin-induced thrombocytopenia: The need for accuracy and speed. Int J Lab Hematol 2021; 43 (Suppl. 01) 96-102
• 17 Warkentin TE, Greinacher A. Laboratory testing for heparin-induced thrombocytopenia and vaccine-induced immune thrombotic thrombocytopenia antibodies: a narrative review. Semin Thromb Hemost 2022;
• 18 Carré J, Jourdi G, Gendron N. et al. Recent advances in anticoagulant treatment of immune thrombosis: a focus on direct oral anticoagulants in heparin-induced thrombocytopenia and anti-phospholipid syndrome. Int J Mol Sci 2021; 23: 93
• 19 Marchetti M, Zermatten MG, Bertaggia Calderara D. et al. Heparin-induced thrombocytopenia: a review of new concepts in pathogenesis, diagnosis, and management. J Clin Med 2021; 10: 683