Abschätzung des Thromboserisikos bei internistischen Patienten

Zusammenfassung

Bei einem thromboembolischen Ereignis handelt es sich möglicherweise um eine vermeidbare Komplikation, wenn das Risiko prospektiv erkennbar ist. Die richtige Einschätzung des individuellen Risikos ist deshalb von herausragender klinischer Bedeutung, bei internistischen Patienten wegen der Komplexität und Multimorbidität älterer Patienten jedoch schwierig. Bei nicht chirurgischen Patienten ist das individuelle Thromboserisiko definiert als Summe aus expositionellen und dispositionellen Risikofaktoren, die nach evidenzbasierter Studienlage gewichtet und in ein Risikoschema umgesetzt werden. In ein praxisnahes und alltagstaugliches Risikoschema können nicht alle klinischen Situationen aufgenommen werden, jedoch erlauben die Schemata in dieser Arbeit die flexible Anwendung und Anpassung an die individuelle Patientensituation in Klinik und ambulanter Versorgung. Damit soll ermöglicht werden, dass der Arzt eine begründete Ja/Nein-Entscheidung zur Thromboseprophylaxe treffen kann.

Summary

Thromboembolic complications can be reduced if the risk can be prospectively identified. Therefore, an adequate individual risk assessment is of clinical significance, but due to complex circumstances and multimorbidity this can be difficult in elderly patients. In non-surgical patients the individual risk of thrombosis can be defined as the sum of exposing and predisposing risk factors, which should be considered according to evidence-based studies and which can be entered in a risk assessment score. A user-friendly risk assessment score cannot reflect all clinical situations. However, the scores discussed in this paper allow for flexibility and an adaptation to the individual situation of various patient populations in the hospital and in the outpatient setting. The use of such a risk assessment score will facilitate objectively based decisions regarding the indication of thromboprophylaxis.

Résumé

Un événement thromboembolique est éventuellement une complication évitable lors de l’identification prospective du risque. L’estimation correcte du risque individuel est par conséquent d’une importance clinique exceptionnelle, tout en étant cependant difficile chez les patients internistiques à cause de la complexité et de la multimorbidité des patients âgés. Chez les patients n’ayant pas subi d’intervention chirurgicale, le risque individuel de thrombose est défini comme la somme des facteurs de risque expositionnels et dispositionnels évalués après étude de la situation basée sur l’évidence et transposés dans un schéma de risques. Toutes les situations cliniques ne peuvent pas être reprises dans un schéma de risques proche de la pratique et approprié à la vie quotidienne ; cependant, dans ce travail les schémas permettent l’utilisation flexible et l’adaptation à la situation individuelle du patient en clinique et dans les soins ambulatoires. Ceci doit permettre au médecin de prendre une décision « oui ou non » justifiée dans la prophylaxie de la thrombose.

Schlüsselwörter

Venöse Thrombose - Innere Medizin - Risikoabschätzung

Keywords

Venous thrombosis - internal medicine - risk assessment

Mots clés

Thrombose veineuse - médecine interne - estimation du risque

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