Diagnostik und Therapie der venösen Thrombose

Zusammenfassung

Für die diagnostische Abklärung einer tiefen Beinvenenthrombose bei ambulanten Patienten empfiehlt es sich, mit der Einstufung in die klinische Wahrscheinlichkeit (KW) sowie mit einem sensitiven D-Dimer-Test zu beginnen. Bei geringer KW und negativem D-Dimer-Test gilt die Thrombose als ausgeschlossen. Alle anderen Konstellationen bedürfen der weiteren Abklärung mittels bildgebender Verfahren. Die Kompressionssonographie steht dabei an erster Stelle. Die Therapie der unkomplizierten Venenthrombose erfolgt vorzugsweise mit niedermolekularem Heparin oder Fondaparinux. So rasch wie möglich wird parallel dazu die Sekundärprophylaxe mit einem Vitamin-K-Antagonisten eingeleitet. Die Behandlungsdauer richtet sich nach den Expositions- und Dispositionsfaktoren unter sorgfältiger Abwägung des Rezidivrisikos einerseits und des Blutungsrisikos andererseits. Die Gefahr eines postthrombotischen Syndroms lässt sich durch eine sofortige und langfristige Kompressionstherapie reduzieren.

Summary

In the diagnosis of deep vein thrombosis in ambulatory patients, the recommended initial steps are assessment of clinical probability (CP) and a sensitive D-dimer test. With a low CP and negative D-dimer, thrombosis can be ruled out. All other constellations require further investigation with imaging techniques. Compression ultrasonography is the first-line investigation. Low-molecular weight heparin or fondaparinux is the treatment of choice for uncomplicated venous thrombosis. Secondary prophylaxis with a vitamin K antagonist is introduced in parallel as quickly as possible. The duration of treatment depends on the exposure and predisposing factors, weighing carefully the risk of recurrence on the one hand against the risk of bleeding on the other. The danger of a post thrombotic syndrome is reduced by the immediate begin of a long lasting compression therapy.

Schlüsselwörter

Beinvenenthrombose - Risikofaktoren - Antikoagulation

Keywords

Deep vein thrombosis - risk factors - anticoagulation

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