Blutungen bei erworbenen komplexen Gerinnungsstörungen wie disseminierter
intravasaler Gerinnung, Trauma-induzierter oder hepatischer Koagulopathie sind
eine hämotherapeutische Herausforderung. Entscheidend für ein erfolgreiches
Blutungsmanagement sind die frühe Erkennung der vorliegenden Gerinnungsstörung
und eine zielgerichtete Therapie mittels Blutkomponenten, Faktorenkonzentraten
und anderer Maßnahmen.
Abstract
Blood loss, consumption or impaired synthesis can lead to a reduction in
platelets and plasmatic coagulation factors in various disease conditions. This
can result in severe bleeding, for example in disseminated intravascular
coagulation (DIC) or trauma-induced coagulopathy (TIC). Bleeding management in
these conditions is challenging due to the fact that anticoagulant hemostasis
components are usually also reduced and fibrinolytic mechanisms are impaired.
Therefore, thrombotic complications can also be prominent features. In addition
to clinical pictures such as DIC and TIC, complex coagulation disorders can also
develop less acute or be present permanently, for example in hepatic
coagulopathy. The treatment of prothrombotic diseases with antiaggregants and
anticoagulants can also trigger or complicate bleeding. A common feature in the
management of DIC and TIC is the importance of timely diagnosis of the acquired
coagulopathy and a targeted therapeutic approach in case of bleeding. This
review article summarizes the main features of laboratory diagnostics and
hemotherapy in DIC and TIC and also addresses the special features of hepatic
coagulopathy and bleeding under antithrombotic medication.
Schlüsselwörter
disseminierte intravasale Gerinnung - Trauma-induzierte Koagulopathie - hepatische
Koagulopathie - Antagonisierung von Antithrombotika
Keyword
disseminated intravascular coagulation - Trauma-induced coagulopathy - hepatic coagulopathy
- antithrombotic drug reversal
