Perioperatives Gerinnungsmanagement

P. Innerhofer

doi:10.1055/s-0037-1616983

Hämostaseologie, Inhaltsverzeichnis

Hamostaseologie 2006; 26(S 01): S3-S14
DOI: 10.1055/s-0037-1616983

Original Article

Schattauer GmbH

Perioperatives Gerinnungsmanagement

Perioperative management of coagulation

Autoren

P. Innerhofer

¹Universitätsklinik für Anästhesie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck

Abstract

Zusammenfassung

Leitlinien offizieller Fachgesellschaften zur Diagnostik und Therapie perioperativer Gerinnungsstörungen basieren nahezu ausnahmslos auf Daten aus der Vollblutära. Die Empfehlungen sehen eine Therapie mit Fresh Frozen Plasma (FFP) und/oder Kryopräzipitat bzw. Transfusion von Thrombozytenkonzentraten im Falle eines von globalen Gerinnungstesten (Werte >1,5fach der Norm, Thrombozyten zahl <50 000 bzw. <100 000/μl) detektierten behandlungswürdigen Defizits vor.

In dieser Arbeit soll auf die Ursachen perioperativer Gerinnungsstörungen, die besondere intraoperative Situation, Veränderungen in der Blutkomponententherapie, aktuell gültige Transfusionstrigger und Effekte der Volumentherapie und die Bedeutung des Gerinnungsfaktors I eingegangen werden. Die Reliabilität von Globaltests als Indikator für eine perioperativen hämostatische Therapie wird in Frage gestellt, die Anwendung der Thrombelastographie als Point-of-care-Methode, sowie ein alternatives Therapiekonzept zur Kompensation von Gerinnungsstörungen mit Einzelfaktorkonzentraten, anstatt oder zusätzlich zur FFPGabe, werden diskutiert und an Hand eines aktuellen Fallberichtes dargestellt.

Summary

Guidelines of official societies for diagnosis and therapy of intraoperatively occurring hypocoagulability rely mainly on data of patients receiving whole blood transfusions. They recommend -provided that laboratory evaluation shows deficiency (values >1.5 fold normal)- administration of fresh frozen plasma, cryoprecipitate and platelet concentrates (platelet count <50 000 or <100 000/μl). This article describes the pathogenesis of coagulopathy in the light of the special intraoperative setting, emphasizes recent changes of blood component preparation, transfusion triggers, effects of volume therapy and challenges standard laboratory assays as reliable guide for intraoperative hemostatic therapy. The role of thrombelastographic monitoring is discussed as well as an alternative strategy to compensate deficiencies by the use of coagulation factor concentrates instead of or in addition to transfusion of FFP, a new concept which is illustrated by the presentation of an actual case report.

Schlüsselwörter

Hämostase - Labormethoden - PT - aPTT - Fibrinogen - Blutverlust - Volumentherapie - Thrombelastographie/Thrombelastometrie - TEG - ROTEM

Keywords

Haemostasis - laboratory testing - PT - aPTT - fibrinogen - haemorrhage - volume therapy - thrombelastography/ thrombelastometry - TEG - ROTEM

Volltext

Referenzen

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