PDF herunterladen
Hamostaseologie 1981; 01(04): 154-159
DOI: 10.1055/s-0038-1656603
Originalarbeiten
Schattauer GmbH

Postoperative Venenthromboseprophylaxe mit Dextran

U. F. Gruber
1   Departement für Chirurgie der Universität Basel, Kantonsspital, Basel
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
21. Juni 2018 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Zusammenfassung

Dextran ist ein Plasmaersatzstoff, welcher antithrombotische Eigenschaften aufweist. Der Wirkungsmechanismus bei der Thromboembolic-Prophylaxe beruht zum Teil auf der Hämodilution und der gesteigerten Durchblutung, zum größten Teil wohl aber auf einem spezifischen, zeitlich limitierten und reversiblen Effekt auf Faktor VIII. Dadurch wird auch die Plättchenfunktion beeinflußt und Thromben, welche in Gegenwart von Dextran entstehen, können durch das körpereigene fibrinolytische System leichter aufgelöst werden. Dextran-Prophylaxe ist vor allem in der Chirurgie sinnvoll, wo die Zufuhr bei elekti-ven Eingriffen bei Narkoseeinleitung beginnt und am ersten postoperativen Tag abgeschlossen wird. Die Gesamtdosis beträgt meist 1500 ml 6% Dextran 70. Aufgrund von methodisch einwandfreien Arbeiten besteht kein Zweifel, daß Dextranprophylaxe die Anzahl postoperativer tödlicher Lungenembolien wirkungsvoll zu senken vermag. In der elektiven allgemeinen Chirurgie ist Dextranprophylaxe gleich wirksam wie 3 × 5000 IE s.c. Natriumheparinat. In der elektiven und notfallmäßigen Orthopädie-traumatologie ist, verglichen mit 2 × 5000 IE Heparin-Dihydergot (DHE) s.c, ebenfalls kein Unterschied in bezug auf Senkung der tödlichen Lungenembolien zu verzeichnen.

 

  • LITERATUR

  • 1 Von Aarburg R, Gruber U. F. Prophylaxe postoperativer thromboembolischer Komplikationen bei hüftgelenksnahen Frakturen. Unfallheilkunde 1978; 81: 475
    PubMedSuche in Google Scholar
  • 2 Åberg M. E, Bergentz S, Hedner U. The effect of dextran on the lysability of ex vivo thrombi. Ann. Surg 1975; 181: 342
    CrossrefPubMedSuche in Google Scholar
  • 3 Åberg M, Hedner U. E, Bergentz S. Effect of dextran on factor VIII (antihemophilic factor) and platelet function. Ann. Surg 1978; 189: 243
    PubMedSuche in Google Scholar
  • 4 Ahlberg A, Nylander G, Robertson B, Cronberg S, Nilsson I. M. Dextran in prophylaxis of thrombosis in fractures of the hip. Acta chir. scand 1968; 387: 83
    PubMedSuche in Google Scholar
  • 5 Ahlberg A. Trombosprofylax med Ma-crodex i ett collumfraktur material. In Haeger och K, Robertsons’s B. Trombus och Status posttromboticus. Studentlitteratur; Lund: 1969: 89
    Suche in Google Scholar
  • 6 Atik M, Harkess J. W, Wichman H. Prevention of fatal pulmonary embolism. Surg. Gynec. Obstet 1970; 130: 403
    PubMedSuche in Google Scholar
  • 7 Barber H. M, Feil E. J, Galasko C. S. B, Edwards D. H, Sutton R. A, Hay-nes D. W, Bentley G. A comparative study of dextran 70 warfarin and low-dose heparin for the prophylaxis of thrombo-embolism following total hip replacement. Postgrad. med. J 1977; 53: 130
    CrossrefPubMedSuche in Google Scholar
  • 8 Becker J, Schampi B. The incidence of postoperative venous thrombosis of the legs. A comparative study on the prophylactic effect of dextran 70 and electrical calf muscle stimulation. Acta chir. scand 1973; 139: 357
    PubMedSuche in Google Scholar
  • 9 Bergentz S. E. Dextran in the prophylaxis of pulmonary embolism. World J. Surg 1978; 2: 19
    CrossrefPubMedSuche in Google Scholar
  • 10 Bergqvist D, Dahlgren S. Leg vein thrombosis diagnosed by 125I-fibrinogen test in patients with fracture of the hip: a study of the effect of early prophylaxis with dicou-marol or dextran 70. VASA 1973; 2: 121
    PubMedSuche in Google Scholar
  • 11 Bergqvist D, Efsing H. O, Hallböök T, Hedlund T. Thromboembolism after elective and posttraumatic hip surgery - a controlled prophylactic trial with dextran 70 and low dose heparin. Acta chir. scand 1979; 145: 213
    PubMedSuche in Google Scholar
  • 12 Bergqvist E, Bergqvist D, Bronge A, Dahlgren S, Lindquist B. An evaluation of early thrombosis prophylaxis following fracture of the femoral neck. Acta chir. scand 1972; 138: 689
    PubMedSuche in Google Scholar
  • 13 Bonnar J, Walsh J. Prevention of thrombosis after pelvic surgery by British dextran 70. Lancet I 1972; 614
    PubMedSuche in Google Scholar
  • 14 Brisman R, Parks L. C, Haller Jr. J. A. Dextran prophylaxis of thromboembolism in high risk surgical patients. Circulation 42 Suppl (Suppl. 111) 1970; 111
    CrossrefPubMedSuche in Google Scholar
  • 15 Brisman R, Parks L. C, Haller Jr. J. A. Dextran prophylaxis in surgery. Ann. Surg 1971; 174: 137
    CrossrefPubMedSuche in Google Scholar
  • 16 Bronge A, Dahlgren S, Lindqvist B. Prophylaxis against thrombosis in femoral neck fractures. A comparison between dextran 70 and dicoumarol. Acta chir. scand 1971; 137: 29
    PubMedSuche in Google Scholar
  • 17 Carter A. E, Eban R. The prevention of postoperative deep venous thrombosis with dextran 70. Brit. J. Surg 1973; 60: 681
    CrossrefPubMedSuche in Google Scholar
  • 18 Daniel W. J, Moore A. R, Flanc C. Prophylaxis of deep vein thrombosis with dextran 70 in patients with a fractured neck of the femur. Austr. N.Z.J. Surg 1972; 41: 289
    PubMedSuche in Google Scholar
  • 19 Davidson A. I, Brunt M. E. A, Matheson N. A. A further trial comparing dextran 70 with warfarin in the prophylaxis of postoperative venous thrombosis. Brit. J. Surg 1972; 59: 314
    PubMedSuche in Google Scholar
  • 20 Evarts C. M, Feil E. I. Prevention of thromboembolic disease after elective surgery of the hip. J. Bone Jt Surg 1971; 53: 1271
    CrossrefPubMedSuche in Google Scholar
  • 21 Gruber U. F. E, Bergentz S. The antithrombotic effect of dextran. J. surg. Res 1966; 6: 379
    CrossrefPubMedSuche in Google Scholar
  • 22 Gruber U. F. Blutersatz. Springer; Berlin-Heidelberg - New York: 1968
    Suche in Google Scholar
  • 23 Gruber U. F. Editorial: Clinical research in thromboembolism. What is important for the urologist?. Urol. Res 1977; 5: 49
    CrossrefPubMedSuche in Google Scholar
  • 24 Gruber U. F. Prevention of thromboembolic complications. The problem and alternatives. Acta Univ. Ups. Symp. Univ. Ups 1977; 3: 55
    PubMedSuche in Google Scholar
  • 25 Gruber U. F, Schnyder M, von Aarburg R. ThromboemboHsche Komplikationen in der Chirurgie des Bewegungsapparates. Orthopäde 1977; 6: 186
    PubMedSuche in Google Scholar
  • 26 Gruber U. F, Duckert F, Fridrich R, Torhorst J, Rem J. Prevention of postoperative thromboembolism by dextran 40 low doses of heparin or xantinol-nicotinate. Lancet I 1977; 207
    PubMedSuche in Google Scholar
  • 27 Gruber U. F, Buser P, Frick J, Loosli J, Matt E, Segesser D. Sulfinpyrazone and postoperative deep vein thrombosis. Europ. Surg. Res 1977; 9: 303
    CrossrefPubMedSuche in Google Scholar
  • 28 Gruber U. F, Saldeen T, Brokop T, Eklöf B, Eriksson I, Goldie I, Gran L, Hohl M, Jonsson T, Kristersson S, Ljungström K. G, Lund T, Maartman Moe H, Svensjö E, Thomson D, Torhorst J, Trippestad A, Ulstein M. Incidences of fatal postoperative pulmonary embolism after prophylaxis with dextran 70 and low dose heparin: an international multicentre study. Br. med. J 1980; 280: 69
    CrossrefPubMedSuche in Google Scholar
  • 29 Gruber U. F, Gorgerat J. F, Kraan P, Bücher H, Buhler J. C, Giezendanner J, Hänni K, Kägi F, Kläy K, Meyer E, Müller H, Naumann K, Neuenschwander S, Parpan D, Pfyl T, Saxer U, Scholler J. M, Schwarz H, Torhorst J. Prevention of fatal postoperative pulmonary embolism by he-parin-dihydroergotamine or dextran 70. Zur Publikation eingereicht
    PubMed
  • 30 Harper D. R, Dhall D. P, Woodruff P. W. H. Prophylaxis in ilic femoral venous thrombosis. The major amputee as a clinical research model. Brit. J. Surg 1973; 60: 831
    CrossrefPubMedSuche in Google Scholar
  • 31 Harris W. H, Salzman E. W, Athana-soulis C, Waltman A. C, Baum S, DeSanctis R. W. Comparison of warfarin low-molecular-weight dextran, aspirin and subcutaneous heparin in prevention of venous thromboembolism following total hip replacement. J. Bone Jt Surg 1974; 56: 1552
    CrossrefPubMedSuche in Google Scholar
  • 32 Hartshorn J. W. S, Teale S. N, Faiz M. Dextran 75 and postoperative phlebitis. Evaluation of dextran 75 in the prophylaxis of postoperative thrombophlebitis, pulmonary embolism and myocardial infarction. Arch. Surg 1969; 98: 694
    CrossrefPubMedSuche in Google Scholar
  • 33 Hedin H. Dextran-induced anaphylactoid reactions in man. Immunological in vitro and in vivo studies. Acta Univ; Ups: 1977: 432
    Suche in Google Scholar
  • 34 Hedlund P. O. Postoperative venous thrombosis in benign prostatic disease. A study of 316 patients using the 1-125-fibrinogen uptake test. Scand. J. Urol. Nephrol Suppl 1975; 27: 100
    PubMedSuche in Google Scholar
  • 35 Hohl M, Lüscher K. P, Tichy J, Stiner M, Fridrich R, Gruber U. F, Käser O. Prevention of postoperative thromboembolism by dextran or low doses of heparin. Obstet. Gynec 1980; 55: 497
    PubMedSuche in Google Scholar
  • 36 Hubens A, Peeters R, Dewilde T, Klaes R. A clinical trial of low molecular weight dextran and low doses of heparin in the prophylaxis of deep vein thrombosis after abdominal surgery. In Greep J. M, de Boer H. H, den Olter G. (eds.) General Surgery, Orthopaedics, Plastic Surgery, Controversial Opinions. Ex-cerpta Medica; Amsterdam and Oxford: 1976: 188
    Suche in Google Scholar
  • 37 Huttunen H. J, Mattila M. A. K, Hakalehto J, Kettunen K, Rehnberg V, Babinsky M. Single infusion of dextran 70 in the prophylaxis of postoperative deep vein thrombosis. Ann. Chir. Gynaec. Fenn 1971; 60: 119
    PubMedSuche in Google Scholar
  • 38 Huttunen H, Mattila M. A. K, Alhava E. M, Kettunen K, Karjalainen P, Poikolainen P, Huttunen K. Peroperative infusion of dextran 70 and dextran 40 in the prevention of postoperative deep venous thrombosis as confirmed by the I-125-label-led fibrinogen uptake method. Ann. Chir. Gynaec. Fenn 1977; 66: 79
    PubMedSuche in Google Scholar
  • 39 Jansen H. Postoperative thromboembolism and its prevention with 500 ml dextran given during operation. Acta chir. Scand Suppl 1972; 427
    PubMedSuche in Google Scholar
  • 40 Johnsson S. R, Bygdeman S, Eliasson R. Effect of dextran on postoperative thrombosis. Acta chir. scand., Suppl 1968; 387: 80
    PubMedSuche in Google Scholar
  • 41 Kline A, Hughes L. E, Campbell H, Williams A, Zlosnick J, Leach K. G. Dextran 70 in prophylaxis of thromboembolic disease after surgery: a clinically oriented randomized double-blind trial. Brit. med. J II 1975; 109
    PubMedSuche in Google Scholar
  • 42 Koekenberg L. J. L. Experimental use of Macrodex as prophylaxis against post-operative thromboembolism. Bull. Soc. Int. Chir 1962; 22: 501
    PubMedSuche in Google Scholar
  • 43 Korvald E, Støren E. J, Ongre A. Simultaneous use of warfarin-sodium and dextran 70 to prevent postoperative venous thrombosis in patients with hip fractures. J. Oslo City Hosp 1973; 23: 25
    PubMedSuche in Google Scholar
  • 44 Lambie J. M, Barber D. C, Dhall D. P, Matheson N. A. Dextran 70 in prophylaxis of postoperative venous thrombosis. A controlled trial. Brit. med. J I 1970; 144
    PubMedSuche in Google Scholar
  • 45 McCarthy T. G, McQueen J, Johnstone F. D, Weston J, Campbell S. A comparison of low-dose subcutaneous heparin and intravenous dextran 70 in the prophylaxis of deep venous thrombosis after gynaecological surgery. J. Obstet. Gynaec. Brit. Cwlth 1974; 81: 486
    CrossrefPubMedSuche in Google Scholar
  • 46 McManus F. The incidence of deep venous thrombosis after total hip replacement using dextran 70 prophylaxis - a venographic study. Irish J. med. Sci 1976; 145: 201
    CrossrefPubMedSuche in Google Scholar
  • 47 Messmer K, Schmid-Schoenbein H. Intentional Hemodilution. Bibl. haemat. Karger; Basel: 1975: 41
    Suche in Google Scholar
  • 48 Myhre H. O, Holen A. Thromboseprofy-lakse. Dextran eller warfarin-natrium?. Nord. Med 1969; 82: 1534
    PubMedSuche in Google Scholar
  • 49 Myrvold H. E, Persson J, Svensson B, Wallensten S, Vikterloef K. J. Prevention of thrombo-embolism with dextran 70 and heparin in patients with femoral neck fractures. Acta chir. scand 1973; 139: 609
    PubMedSuche in Google Scholar
  • 50 Nillius S. A. On thromboembolism after total hip replacement. Thesis; University of Lund, Malmö: 1978
    Suche in Google Scholar
  • 51 Renney J. T. G, Kakkar V. V, Nicolaides A. N. The prevention of postoperative deep-vein thrombosis comparing dextran 70 and intensive physiotherapy. Brit. J. Surg 1970; 57: 388
    PubMedSuche in Google Scholar
  • 52 Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet I 1977; 466
    PubMedSuche in Google Scholar
  • 53 Ruckley C. V. Heparin versus dextran in the prevention of deep-vein thrombosis. A multi-unit controlled trial. Lancet II 1974; 118
    PubMedSuche in Google Scholar
  • 54 Salzman E. W. Drugs affecting platelets function in venous thromboembolism. Thromb. Diath. Hemorrh., Suppl 1974; 60: 497
    PubMedSuche in Google Scholar
  • 55 Sawyer R. B. Clinical experiences with dextran treatment. Acta chir. scand., Suppl 1968; 387: 58
    PubMedSuche in Google Scholar
  • 56 Smith R. C, Elton R. A, Orr J. D, Hart A. J. L, Graham D. F, Fuller G. A. G, Rundle J. S, MacPherson A. I. S, Ruck-ley C. V. Dextran and intermittent pneumatic
    PubMed
  • 57 compression in prevention of postoperative deep vein thrombosis cmuitiunit trial. Brit. med. J 1978; 1: 952
    CrossrefPubMedSuche in Google Scholar
  • 58 Sobotka M. R. Prevention of postoperative deep venous thrombosis by low-molecular weight dextran. In Green J. M, de Boer H. H. M, den Olter G. (eds.) General Surgery, Orthopaedics, Plastic Surgery, Controversial Opinions. Excerpta Medica; Amsterdam and Oxford: 1976: 184
    Suche in Google Scholar
  • 59 Schaub N, Duckert F, Fridrich R, Gruber U. F. Häufigkeit postoperativer tiefer Venenthrombosen bei Patienten der Allgemeinen Chirurgie und Urologie. Eine Untersuchung mit dem 125J-Fibrinogentest bei 95 Patienten ohne medikamentöse Prophylaxe. Arch. klin. Chir 1975; 340: 23
    CrossrefPubMedSuche in Google Scholar
  • 60 Schnyder M, Graber U. F. Prophylaxe postoperativer tiefer Venenthrombosen in der elektiven Hüftchirurgie. Akt. Trauma-tol 1977; 7: 275
    PubMedSuche in Google Scholar
  • 61 Stadil F. Prevention of venous thrombosis. Lancet II 1970; 50
    PubMedSuche in Google Scholar
  • 62 Steinmann E, Duckert F, Gruber U. F. Wert von Dextran 70 zur Thromboseprophylaxe in der allgemeinen Chirurgie. Orthopädie, Urologie und Gynäkologie. Schweiz, med. Wschr 1975; 105: 1637
    PubMedSuche in Google Scholar
  • 63 Stephenson C. B. S, Wallace J. C, Vaughan J. V. Dextran 70 in the prevention of post-operative deep-vein thrombosis with observations on pulmonary embolism: Report on a pilot study. New Zeald. med. J 1973; 77: 302
    PubMedSuche in Google Scholar
  • 64 Van Geloven F, Wittebol P, Sixma J. J. Comparison of postoperative coumarin dextran 40 and subcutaneous heparin in the prevention of postoperative deep vein thrombosis. Acta med. scand 1977; 202: 367
    PubMedSuche in Google Scholar
  • 65 Von Hospenthal J, Frey Ch, Rutishau-ser G, Gruber U. F. Thromboseprophylaxe bei transurethraler Prostataresektion. Urologe A 1977; 16: 88 63. 61/159
    PubMedSuche in Google Scholar