Adipositas und das Risiko für venöse Thrombosen und Embolien

Zusammenfassung

Ein intravaskulärer venöser Thrombus ohne Gefäßverletzung ist als Blutgerinnung an falscher Stelle und zum falschen Zeitpunkt zu betrachten und tritt als Folge eines Ungleichgewichts zwischen Koagulation und Fibrinolyse auf. Durch Verschleppung eines Thrombus über das rechte Herz in die Lungenstrombahn entsteht eine Lungenarterienembolie. Viele Faktoren erhöhen das Risiko dafür, so Immobilisierung, Verletzung, Operation, aber auch Alter, Rauchen, manche Medikamente und Adipositas. Zwar bringen diese Faktoren einzeln jeweils nur eine geringe Risikosteigerung um das 1,5–2,0-Fache mit sich, das gleichzeitige Vorliegen mehrerer Risikofaktoren wird aber zum Problem. Bariatrische Patienten stellen daher eine besonders gefährdete Gruppe für ein thromboembolisches Ereignis dar. Bei Adipositas tragen erhöhter intraabdomineller Druck, gesteigerte Aktivierbarkeit der Thrombozyten, gesteigerte Synthese mancher Gerinnungsfaktoren und endogener Inhibitoren der Fibrinolyse sowie die größere Dichte von Fibringerinnseln zum erhöhten Risiko bei. Gewichtsreduktion beeinflusst vieles davon, aber belastbare Daten für eine Reduktion des Thromboserisikos durch Gewichtsreduktion liegen derzeit nicht vor.

Summary

Formation of an intravascular thrombus without vascular injury represents coagulation at the wrong place and time. The event results from a dysbalance between coagulation and fibrinolysis. Dislocation of such a thrombus through the right heart into pulmonary vessels may result in lung artery embolism. The risk of thromboembolism is increased by many factors, e.g. immobilization, trauma, surgery, but more common also increasing age, smoking, some drugs, and obesity. Many of these factors individually increase thromboembolic risk only by 1.5–2.0-fold, but the concomitant presence of several risk factors leads to clinically significant problems. With this respect, patients undergoing bariatric surgery are at particularly high thromboembolic risk. In obese individuals the risk increases through high intraabdominal pressure, increased potency to activate thrombocytes, increased synthesis of some coagulation factors and of endogenous fibrinolysis inhibitors as well as increased fibrin clot density. Weight reduction positively influences several of these factors, but conclusive data that suggest decreased thromboembolic event rates following weight reduction are still missing.

Schlüsselwörter

Thrombose - Embolie - Adipositas - bariatrische Operation - Fibrinolyse - Gewichtsreduktion

Keywords

Thrombosis - embolism - obesity - bariatric surgery - fibrinolysis - weight reduction

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