Therapie der tiefen Beinvenenthrombose

Zusammenfassung

Neben der Kompressionsbehandlung ist die Antikoagulation die wichtigste Maßnahme bei der Behandlung akuter tiefer Beinvenenthrombosen. Niedermolekulare Heparine (NMH) sind in der Behandlung der tiefen Beinvenenthrombose genauso wirksam oder etwas wirksamer als unfraktioniertes Heparin (UFH). Inzwischen haben sich die NMH in der Behandlung der tiefen Beinvenenthrombose weitgehend durchgesetzt. Diskutiert wird allerdings noch über den Wirkmechanismus, die optimale Dosis und die optimale Therapiedauer. Zunehmend häufiger werden Patienten mit tiefer Beinvenenthrombose schon nach kurzer stationärer Behandlung entlassen oder auch ausschließlich ambulant behandelt. Vorteile der NMH sind in diesen Fällen ihre bessere Bioverfügbarkeit und die deutlich einfachere Handhabung der Anwendung als s.c. Gabe. Neue Medikamente werden in Kürze verfügbar sein. Hierzu gehören besonders das Pentasaccharid und oral wirksame Thrombinhemmer wie Melagatran. Es bleibt abzuwarten, ob diese neuen Wirkstoffe die Therapie der tiefen Beinvenenthrombose weiter verbessern können. Die fibrinolytische Behand-lung der tiefen Beinvenenthrombose ist bisher mit einem erhöhten Blutungsrisiko verbunden. Neue Fibrinolytika und neue Applikationsformen könnten dieser Therapieform wieder zu einem höheren Stellenwert verhelfen.

Summary

Besides compression bandaging anticoagulation ist the most important part of treatment of acute deep venous thrombosis. Low-molecular-weight heparins (LMWH) are equally effective in the treatment of deep vein thrombosis as unfractionated heparin (UFH). Meanwhile LMWH have become the treatment of choice for acute deep venous thrombosis. The optimal dose, the optimal duration of treatment and the mechanism of action of LMWH are still under discussion. Increasingly patients with deep vein thrombosis treated with LMWH are discharged from hospital early or even primarily treated as outpatients. Advantages of LMWH are the increased bioavailability, the easier handling and the possibility of early mobilisation. New drugs will soon be available. Among those pentasaccharide and oral thrombin inhibitors as melagatran are currently studied. It remains to be seen whether these new anticoagulants may further improve the treatment of patients with deep venous thrombosis. Fibrinolytic treatment of acute deep venous thrombosis is connected with an increased bleeding risk. New fibrinolytic agents and new forms of application may increase the role of fibrinolytic treatment of deep venous thrombosis in the future.

Schlüsselwörter

Heparin - niedermolekulare Heparine - Lungenembolie - Phebographie - Rückbildung der Thrombose

Keywords

Heparin - low-molecular-weight heparins - pulmonary embolism - phebography - thrombus regression

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