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Hamostaseologie 2002; 22(04): 161-166
DOI: 10.1055/s-0037-1619554
Research Articles
Schattauer GmbH

Prävention von Katheterthrombosen mit niedermolekularen Heparinen

Prevention of catheter-induced thromboses by low molecular weight heparins
Ch. Lersch
1   II. Medizinische Klinik und Poliklinik der Technischen Universität München (Leiter: Prof. Dr. Dres. h.c. mult. M. Classen), Klinikum rechts der Isar, München
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Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Infektionen und Thrombosen sind die häufigsten Komplikationen bei zentralvenösen Kathetern (ZVK). Das Auftreten von katheterinduzierten Thrombosen kann durch das Material (z. B. Silikon und Polyurethan), geringe Dicke, bestimmte ZVK-Systeme, Vermeidung von Infektionen, korrekte Lage der ZVK-Spitze in der unteren Vena cava superior und durch kurze Liegedauer deutlich vermindert werden. Dagegen sind Thrombosefördernde, Katheter-unabhängige Faktoren (z. B. Tumorerkrankung), hohes Lebensalter, zusätzliche Strahlen- und Chemotherapie schwerer beeinflussbar. Neben Katheterbeschichtung, oralen Antikoagulanzien, Thrombozytenaggregationshemmern und Urokinase werden unfraktionierte und vor allem niedermolekulare Heparine zur Thromboseprophylaxe eingesetzt. Nach den positiven Ergebnissen der Studie von Monreal, einer multizentrischen Beobachtungsstudie und einer eigenen retrospektiven Analyse bei Patienten mit Portsystemen erhalten alle eigenen Patienten mit fortgeschrittenen gastrointestinalen Tumoren und palliativer Chemotherapie eine konsequente Prophylaxe mit NMH über mindestens 90 Tage. Mögliche zusätzliche Antitumoreffekte der NMH werden zurzeit evaluiert.

Summary

Infections and thromboses are the most frequent complications of central venous catheters (cvc). The use of a special material (i. e. polyurethane, silicone) and type (i. e. Hickman) small in diameter, the avoidance of any infection as well as the optimal position of the cvc tip in the lower part of the vena cava superior and a short period of catheterisation will be effective in decreasing the number of thromboses, whereas other thrombogenic factors (i. e. malignant disease), the patient’s age, additional chemo- and/or radiotherapy cannot practically be influenced. Coated cvc, oral anticoagulants, acetylsalicylic acid, and low dose urokinase, unfractionated and predominantly low molecular weight heparins (LMWH) are in use to avoid thromboses. Our outpatients with progressed gastrointestinal malignancies, port systems, and systemic chemotherapy consequently receive a prophylaxis with LMWH for at least 90 days according to the beneficial results published in three studies. Additional antitumoral effects of LMWH are presently evaluated and will favour consequent LMWH prophylaxis in patients with advanced malignancies and permanent catheters.

Schlüsselwörter

Niedermolekulare Heparine - Katheter - Thromboseprophylaxe

Keywords

Low molecular weight heparins - catheter - thrombosis - prophylaxis
 

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