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Hamostaseologie 1981; 01(04): 154-159
DOI: 10.1055/s-0038-1656603
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Postoperative Venenthromboseprophylaxe mit Dextran

U. F. Gruber
1   Departement für Chirurgie der Universität Basel, Kantonsspital, Basel
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Publication Date:
21 June 2018 (online)

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Zusammenfassung

Dextran ist ein Plasmaersatzstoff, welcher antithrombotische Eigenschaften aufweist. Der Wirkungsmechanismus bei der Thromboembolic-Prophylaxe beruht zum Teil auf der Hämodilution und der gesteigerten Durchblutung, zum größten Teil wohl aber auf einem spezifischen, zeitlich limitierten und reversiblen Effekt auf Faktor VIII. Dadurch wird auch die Plättchenfunktion beeinflußt und Thromben, welche in Gegenwart von Dextran entstehen, können durch das körpereigene fibrinolytische System leichter aufgelöst werden. Dextran-Prophylaxe ist vor allem in der Chirurgie sinnvoll, wo die Zufuhr bei elekti-ven Eingriffen bei Narkoseeinleitung beginnt und am ersten postoperativen Tag abgeschlossen wird. Die Gesamtdosis beträgt meist 1500 ml 6% Dextran 70. Aufgrund von methodisch einwandfreien Arbeiten besteht kein Zweifel, daß Dextranprophylaxe die Anzahl postoperativer tödlicher Lungenembolien wirkungsvoll zu senken vermag. In der elektiven allgemeinen Chirurgie ist Dextranprophylaxe gleich wirksam wie 3 × 5000 IE s.c. Natriumheparinat. In der elektiven und notfallmäßigen Orthopädie-traumatologie ist, verglichen mit 2 × 5000 IE Heparin-Dihydergot (DHE) s.c, ebenfalls kein Unterschied in bezug auf Senkung der tödlichen Lungenembolien zu verzeichnen.

 

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