Aktuelle Aspekte zu Diagnostik und Therapie der tiefen Venenthrombose aus internistischer Sicht

Zusammenfassung

Die tiefe Venenthrombose stellt eine häufige Erkrankung dar, deren klinische Diagnose aufgrund der unspezifischen Symptomatik oft unsicher ist. Die diagnostische Methode der Wahl ist heute die Kompressions- oder Duplexsonographie. Bei unsicheren Befunden ist eine Phlebographie indiziert. Im Rahmen der Ursachenklärung spielen die verschiedenen Thrombophilien, bei älteren Patienten auch die Tumorsuche, eine wichtige Rolle. Die klassische Behandlung besteht aus der therapeutischen Antikoagulation mit Heparin, die möglichst rasch eingeleitet werden muss, sowie der anschließenden Sekundärprophylaxe. Niedermolekulare Heparine stellen heute die Therapie der Wahl in der Initialphase dar, sie bieten den Vorteil der einfacheren und sichereren Anwendung sowie die Möglichkeit zur früheren Mobilisierung und ambulanten Therapie. Im Rahmen der Sekundärprophylaxe kommen orale Antikoagulanzien zum Einsatz, bei Kontraindikationen ist auch hier der Einsatz von niedermolekularen Heparinen möglich. Die Dauer ist dabei vor allem von Lokalisation und Ausdehnung der Thrombose sowie von begleitenden Risikofaktoren abhängig und muss individuell festgelegt werden. Eine wichtige Rolle bei der Verhinderung postthrombotischer Syndrome spielt die Kompressionsbehandlung. Durch die Entwicklung neuer antithrombotischer Wirkstoffe wie Pentasaccharide oder orale Thrombininhibitoren ergeben sich neue Perspektiven in der Prophylaxe und Therapie thromboembolischer Erkrankungen.

Abstract

Deep vein thrombosis is a common disease, but clinical diagnosis is often unreliable due to unspecific symptoms. Today, compression or duplex ultrasonography is the diagnostic method of choice in most patients. Venography should be performed in case of uncertain ultrasound test results. Predisposing factors for venous thromboembolism like thrombophilias or malignant disease should be examined. By initial treatment with heparin a therapeutic range should be reached as soon as possible. Low molecular weight heparins are the initial treatment of choice, they are at least as effective and safe as unfractionated heparin. Due to the advantage of simplicity of administration, they have the potential for ambulant treatment. Initial heparin therapy is usually followed by long-term treatment with oral anticoagulants, in case of contraindications use of low molecular weight heparins is also possible. The optimal duration depends on localization of thrombosis and concomitant risk factors, and should be individualized. Compression therapy should be performed to reduce the incidence of postthrombotic syndrome. Development of new antithrombotic agents like pentasaccharides or oral thrombin inhibitors has raised new possibilities in prophylaxis and treatment of venous thromboembolism.

Tiefe Venenthrombose - Diagnostik - Therapie - Antikoagulation - NMH - Thrombophilie

Deep vein thrombosis - diagnosis - treatment - anticoagulation - LMWH - thrombophilia

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