Erworbene Koagulopathien

Zusammenfassung

Erworbene Koagulopathien sind meist Folgen einer verursachenden Grundkrankheit (z. B. Leberinsuffizienz oder Sepsis). Die adäquate Behandlung dieser Grundkrankheit ist in der Regel von langfristig prognosebestimmender Bedeutung. Bei wenigen Koagulopathien, insbesondere bei den Immunkoagulopathien, findet sich aber keine erkennbare Grundkrankheit bei einem relevanten Anteil von Patienten. Die Optimierung der Hämostase mit dem Ziel fatale Blutungskomplikationen oder Thromboembolien zu verhindern, ist in beiden Fällen in der Lage, die Prognose zu verbessern. Meist gelingt dies durch individuell angepasste laborkontrollierte Therapien, die nur schwer einer Überprüfung im Rahmen von Studien zugänglich sind. In den vergangenen Jahren wurde erstmals in plazebokontollierten randomisierten Phase-III-Studien die Bedeutung der therapeutischen Hämostasemodulation zur Mortalitätsreduktion erfolgreich überprüft.

Summary

Acquired coagulopathies regularly result from underlying diseases such as liver failure or sepsis. Optimal treatment of these underlying diseases defines longterm prognosis. In a few coagulopathies, such as immunocoagulopathies, in a relevant portion of patients an underlying disease cannot be identified. Therapeutic modulation of haemostasis aiming at the prevention of fatal bleeding or thromboembolism is able to improve the prognosis of patients with acquired coagulopathies. Most often this is the result of individualized, lab-controlled treatments, which are difficult to be studied. Within the last years the role of therapeutic modulation of haemostasis to reduce mortality was successfully studied for the first time in the frame of randomized placebo-controlled phase III studies.

Schlüsselwörter

Erworbene Koagulopathie - Leberinsuffizienz - Niereninsuffizienz - DIC - erworbene Hemmkörper - Sepsis

Keywords

Acquired coagulopathy - liver failure - renal failure - DIC - acquired inhibitors - sepsis

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