Neuere Methoden und Testsysteme in der Haemostasediagnostik – Messmethoden und klinische Überwachung relevanter Therapien

In den neuen Konzepten zur Blutgerinnungsaktivierung haben die Interaktionen der Blutzellen und plasmatischen Gerinnungsfaktoren sowie die Dynamik der Thrombinbildung eine zentrale Bedeutung. Die klassische Gerinnungskaskade mit extrinsischem und intrinsischem System als Modell der Gerinnungsaktivierung wurde abgelöst von einem Modell von überlappenden Phasen der Aktivierung und Verstärkung des Hämostaseprozesses. Parallel zum sich weiterentwickelnden Verständnis des Gerinnungssystems haben auch neue Verfahren zur laborchemischen Analyse dieser Mechanismen in die Routine Einzug gefunden, die häufig auch im Vollblut durchgeführt werden. Auch die klassischen Globaltests PT (Prothrombinzeit) und aPTT (aktivierte partielle Thromboplastinzeit) werden zunehmend patientennah im Vollblut durchgeführt. Dieser Artikel stellt neue Methoden zur Messung der Hämostase dar, die insbesondere in der klinischen Überwachung von hämostaserelevanten Therapien Einsatz finden.

Of superior importance for the novel concepts of activation of blood coagulation are the interactions of blood cells, the plasmatic coagulation factors and the dynamics of thrombin formation. A novel model of overlapping phases of activation and intensification of hemostatic processes has now replaced the outdated ”classical„ model of activation of coagulation by the coagulation cascade and its extrinsic and intrinsic system. Parallel to the growing understanding of the system of coagulation, novel routines of laboratory chemical analysis – which are often conducted with full blood – have been developed. Furthermore, also the classical global tests PT (prothrombin time) and aPTT (activated partial thromboplastin time) are being increasingly performed with full blood, i.e. close to the patient. The following contribution presents new methods for measuring hemostasis that are specifically employed in the clinical control of hemostastically relevant therapies.

Key words

Hemostasis - thrombosis - bleeding - thromboplastin time (TPT) - testing systems

Literatur

• 1 Avidan MS, Alcock El, Da Fonseca JH. et al. . Comparison of structured use of routine laboratory tests or near–patient assessment with clinical judgement in the management of bleeding after cardiac surgery.  Br J Anaesth. 2004;  92 178-186
• 2 Calatzis A, Heesen M, Spannagl M.. Patientennahe Sofortdiagnostik von Hämostaseveränderungen in der Anästhesie und Intensivmedizin.  Anaesthesist. 2003;  52 229-237
• 3 Cammerer U, Dietrich W, Rampf T. et al. . The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery.  Anesth Analg. 2003;  96 51-57
• 4 Crescente M, Di Castelnuovo A, Iacoviello L. et al. . PFA–100 closure time to predict cardiovascular events in aspirin–treated cardiovascular patients. A meta–analysis of 19 studies comprising 3.003 patients.  Thromb Haemost. 2008;  99 1129-1131
• 5 Despotis GJ, Goodnough LT.. Management approaches to platelet–related microvascular bleeding in cardiothoracic surgery.  Ann Thorac Surg. 2000;  70 20-32
• 6 Eichinger S, Hron G, Kollars M, Kyrle PA.. Prediction of recurrent venous thromboembolism by endogenous thrombin potential and D–dimer.  Clin Chem. 2008;  54 2042-2048
• 7 Ferring M, Reber G, de Moerloose P. et al. . Point of care and central laboratory determinations of the aPTT are not interchangeable in surgical intensive care patients.  Can J Anaesth. 2001;  48 1155-1160
• 8 Hemker HC, Al Dieri R, De Smedt E, Beguin S.. Thrombin generation, a function test of the haemostatic–thrombotic system.  Thromb Haemost. 2006;  96 553-561
• 9 Hicks JM, Haeckel R, Price CP. et al. . Recommendations and opinions for the use of point–of–care testing for hospitals and primary care: summary of a 1999 symposium.  Clin Chim Acta. 1999;  303 1-17
• 10 Luddington RJ.. Thromboelatography.  Clin Lab Haematol. 2005;  27 81-90
• 11 Murray DJ, Brosnahan WJ, Pennell B. et al. . Heparin detection by the activated coagulation time: a comparison of the sensitivity of coagulation tests and heparin assays.  J Cardiothorac Vasc Anesth. 1997;  11 24-8
• 12 Orbe J, Zudaire M, Serrano R. et al. . Increased thrombin generation after acute versus chronic coronary disease as assessed by the thrombin generation test.  Thromb Haemost. 2008;  99 382-387
• 13 Shore–Lesserson L, Manspeizer HE, DePerio M. et al. . Thromboelastography–guided transfusion algorithm reduces transfusions in complex cardiac surgery.  Anesth Analg. 1999;  88 312-319
• 14 Simon DI, Liu CB, Ganz P. et al. . A comparative study of light transmission aggregometry and automated bedside platelet function assays in patients undergoing percutaneous coronary intervention and receiving abciximab, eptifibatide, or tirofiban.  Catheter Cardiovasc Interv. 2001;  52 425-432
• 15 Tanaka KA, Szlam F, Sun HY. et al. . Thrombin generation assay and viscoelastic coagulation monitors demonstrate differences in the mode of thrombin inhibition between unfractionated heparin and bivalirudin.  Anesth Analg. 2007;  105 933-939
• 16 Theusinger OM, Nürnberg J, Asmis LM. et al. .Rotation thromboelastometry (ROTEM((®))) stability and reproducibility over time. Eur J Cardiothorac 2009
• 17 Tódt O, Calatzis A, Penz S. et al. . Multiple electrode aggregometry: a new device to measure platelet aggregation in whole blood.  Thromb Haemost. 2006;  96 781-788
• 18 Yuoh C, Tarek M Elghetany, Petersen JR. et al. . Accuracy and precision of point–of–care testing for glucose and prothrombin time at the critical care units.  Clin Chim Acta. 2001;  307 119-123
• 19 Zucker ML.. The National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Point of Care Coagulation Testing.  Point of Care. 2007;  6 223-226

Korrespondenz