Konservative Therapie der akuten Becken-Beinvenenthrombose[*]

Conservative treatment of acute deep vein thrombosis of the lower extremity

Summary

During the acute phase of the disease the aim of conservative treatment of DVT is relief of symptoms as well as prevention of thrombus progression and pulmonary embolism. In the chronic phase treatment should prevent recurrence and postthrombotic syndrome. Besides general measures such as compression therapy, elevation of the leg and mobilisation anticoagulation therapy with heparin and coumarin has been proved to be successful. Even though not more effective or safer low-molecular weight heparin has recently replaced unfractionated heparin in the initial treatment of DVT mainly because of its more convenient use allowing modern ambulatory and outdoor treatment. Doses depend on the kind of heparin used. In the secondary prevention therapy with coumarins, an INR of 2-3 is generally accepted whereas the duration of oral anticoagulant therapy is under discussion. Compression therapy is recommended for at least 2 years, in case of postthrombotic syndrome life-long therapy is necessary. When comparing the effectivness of DVT-treatment today with the results in the pre-anticoagulant era, the modern treatment is more effective, safe and cost-effective; it also guarantees more quality of life, but the long-term results have to be improved.

Zusammenfassung

In der Akutphase der Becken-Beinvenenthrombose wird neben einer raschen Symptomfreiheit des Patienten die Verhinderung einer Thrombusausdehnung und Pulmonalembolie angestrebt, in der chronischen Phase eine Senkung der Rezidivrate und des postthrombotischen Syndroms. Hierzu stehen neben Allgemeinmaßnahmen (Kompressionsbehandlung, Hochlagerung der Extremität, Mobilisation) die Antikoagulationsbehandlung mit Heparin und Coumarinen zur Verfügung. Obwohl nicht effektiver oder sicherer als unfraktioniertes Heparin, bestechen die niedermolekularen Heparine durch die Einfachheit ihrer Handhabung und bieten so ideale Voraussetzungen für die moderne ambulatorische und ambulante Thrombosetherapie. Die Dosierung erfolgt körpergewichtsbezogen produktspezifisch. Während eine Intensität der Sekundärprophylaxe mit Coumarinen im Bereich einer INR von 2-3 allgemein akzeptiert wird, ist ihre optimale Dauer noch Gegenstand der Diskussion. Eine Kompressionsbehandlung sollte für mindestens 2 Jahre durchgeführt werden, bei Auftreten eines postthrombotischen Syndroms lebenslang. Vergleicht man die heutigen Therapieergebnisse mit denen der Ära vor Einführung der Antikoagulationsbehandlung, so zeigt sich, daß die moderne konservative Thrombosebehandlung in der Akutphase wesentlich effektiver, sicherer und kostenbewußter ist und dem Patienten mehr Lebensqualität gewährt, die Ziele der chronischen Behandlungsphase werden bisher allerdings nur unzureichend erreicht.

Deep vein thrombosis - medical treatment - anticoagulation - low-molecular weight heparin - coumarin - compression therapy

Thrombose - konservative Behandlung - Antikoagulation - niedermolekulare Heparine - Coumarine - Kompressionsbehandlung

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1 Vortrag, gehalten auf dem Robert May-Gedächtniskongress, Innsbruck, 18.-20. Mai 2000