Zusammenfassung
Jeder 4. Schwerverletzte weist bereits bei Krankenhausaufnahme eine traumainduzierte
Koagulopathie (TIK) auf, die mit einer 4-fach erhöhten Mortalität einhergeht. Rasche
und zielgenaue Behandlung kann die TIK-assoziierte Sterblichkeit senken. Point-of-Care-Tests
ermöglichen im Vergleich mit herkömmlichen Labormethoden eine zeitnahe und umfassende
Bestimmung des Gerinnungsstatus sowie eine zielgerichtete Therapie.
Abstract
In severely injured patients, trauma-induced coagulopathy (TIC) present at hospital
admission is associated with increased transfusion requirements, morbidity and mortality.
Early and effective treatment contributes to improved survival rates. Laboratory coagulation
assays have long turn-around times and evidence for their usefulness, especially in
the context of TIC, is weak. Due to the lack of appropriate guidance, transfusion
of allogeneic blood products frequently follows a ratio-based concept (e.g., transfusion
of erythrocytes and plasma in a 1 : 1 ratio). Point-of-care (PoC) tests enable the
assessment of prothrombin time (PT) and activated partial thromboplastin time in few
minutes. However, although normal PT in these tests allows to rule out relevant effects
of several anticoagulants, they are not able to detect patients with TIC and/or requiring
subsequent massive transfusion. Viscoelastic tests (VETs) make it possible to assess
defects in thrombin generation, hypofibrinogenaemia, thrombocytopenia, and hyperfibrinolysis,
and thus enable targeted therapy. Impairment of platelet function is the common blind
spot not detectable using both standard laboratory-based tests and VETs. However,
PoC platelet function tests enable to detect platelet defects and patients taking
anti-platelet. Furthermore, impaired platelet function has been identified as a strong
predictor for coagulopathy and massive transfusion in trauma patients. In other clinical
settings, coagulation management based on VETs is associated with decreased transfusion
requirements, incidence of acute kidney failure, and mortality, respectively. Data
of the first small prospective randomised trial indicate superiority of VET guided
coagulation management solely using coagulation factor concentrates, when compared
to plasma transfusions in severe trauma.
Schlüsselwörter
Traumatologie - Gerinnungsstörung - Diagnostik - Koagulopathie - Thrombozytenfunktion
Key words
trauma - coagulation disorder - diagnostics - coagulopathy - platelet function
