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Anästhesiol Intensivmed Notfallmed Schmerzther 2004; 39(7): 415-443
DOI: 10.1055/s-2004-825697
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© Georg Thieme Verlag KG Stuttgart · New York

Perioperative Gerinnungsstörungen

Perioperative Coagulation DisordersR.  U.  Scherer1 , R.  M.  Giebler2
  • 1Zentrale Abteilung für Anästhesiologie und Intensivmedizin, Evangelisches und Johanniter Klinikum Duisburg/Dinslaken/Oberhausen gGmbH
  • 2Abteilung für Anästhesiologie, Intensivmedizin und Rettungsmedizin, Evangelisches Jung-Stilling-Krankenhaus Siegen
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Publication History

Publication Date:
26 July 2004 (online)

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Weiterbildungsziele In diesem Beitrag sollen folgende Weiterbildungsziele vermittelt werden: Antikoagulatorische Medikamente einschließlich der neueren Thrombozytenaggregationshemmer und Thrombininhibitoren Zeitliche Sicherheitsabstände bei antikoagulatorischer Medikation Physiologie der Gerinnungsaktivierung und -inhibierung Klinische Differenzierung statischer und dynamischer Gerinnungsstörungen Interpretation globaler Laborwerte Therapieoptionen und Indikationen für Gerinnungspräparate

Literatur

  • 1 Latzka R, Koscielny J, Pruß A, Kiesewetter H. Klinischer Einsatz von Desmopressin und Antifibrinolytika.  Anästh Intensivmed. 1999;  40 548-553
    PubMedSearch in Google Scholar
  • 2 McKenna R. Abnormal coagulation in the postoperative period contributing to excessive bleeding.  Med Clinic North Am. 2001;  85 1277-1310
    PubMedSearch in Google Scholar
  • 3 Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery.  N Engl J Med. 1997;  336 1506-1511
    CrossrefPubMedSearch in Google Scholar
  • 4 Robinson K L, Marasco S F, Street A M. Practical management of anticoagulation, bleeding and blood product support for cardiac surgery. Part one: bleeding and anticoagulation issues.  Heart, Lung and Circulation. 2001;  10 142-153
    CrossrefPubMedSearch in Google Scholar
  • 5 Pastakia K B, Terle D, Prodouz K N. Penicillin-induced dysfunction of platelet membran glycoproteins.  J Lab Clin Med. 1993;  121 546-554
    PubMedSearch in Google Scholar
  • 6 Burroughs S F, Johnson G J. Beta-lactam antibiotic-induced platelet dysfunction: evidence of irreversible inhibition of platelet activation in vitro and in vivo after prolonged exposure to penicillin.  Blood. 1990;  75 1473-1480
    PubMedSearch in Google Scholar
  • 7 Cazzola M, Matera M G, Santangelo G, Lampa E, Angrisani M, Loffreda A, Rossi F. Effects of some cephalosporins and teicoplanin on platelet aggregation.  Int J Clin Pharmacol Res. 1993;  13 69-73
    PubMedSearch in Google Scholar
  • 8 Opal S M, Kessler C M, Roemisch J, Knaub S. Antithrombin, heparin, and heparan sulfate.  Crit Care Med. 2002;  30 (suppl) S325-S331
    CrossrefPubMedSearch in Google Scholar
  • 9 Hirsh J, Warkentin T E, Shaughnessy S G, Anand S S, Halperin J L, Raschke R, Granger C, Ohman E M, Dalen J E. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety.  Chest. 2001;  119 Suppl 64S-94S
    CrossrefPubMedSearch in Google Scholar
  • 10 Greinacher A. Antikoagulation bei HIT II. Wann therapeutisch - wann prophylaktisch?.  Anästhesiol Intensivmed Notfallmed Schmerzther. 2002;  37 Suppl 1 3-7
    PubMedSearch in Google Scholar
  • 11 Gerlach R, Scheuer T, Beck J, Woszczyk A, Seifert V, Raabe A. Risk of postoperative hemorrhage after intracranial surgery after early nadroparin administration: results of a prospective study.  Neurosurgery. 2003;  53 1028-1034
    CrossrefPubMedSearch in Google Scholar
  • 12 Roberts H R, Monroe D M, Escobar M A. Current concepts of hemostasis.  Anesthesiology. 2004;  100 722-730
    CrossrefPubMedSearch in Google Scholar
  • 13 Holst J, Lindblad B, Bergqvist D, Garre K, Nielsen H, Hedner U, Ostergaard P B. Protamine neutralization of intravenous and subcutaneous low-molecular-weight heparin (tinzaparin, Logiparin): An experimental investigation in healthy volunteers.  Blood Coagul Fibrinolysis. 1994;  5 795-803
    PubMedSearch in Google Scholar
  • 14 Gibbs N M, Weightman W M, Thackray N M, Michalopoulos N, Weidmann C. The effects of recent aspirin ingestion on platelet function in cardiac surgical patients.  J Cardiothorac Vasc Anesth. 2001;  15 55-59
    CrossrefPubMedSearch in Google Scholar
  • 15 Schafer A. effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis.  J Clin Pharmacol. 1995;  35 209-219
    PubMedSearch in Google Scholar
  • 16 Tuman K J, McCarthy R J, O'Connor C J, McCarthy W E, Ivankovich A D. Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery.  Anesth Analg. 1996;  83 1178-1184
    PubMedSearch in Google Scholar
  • 17 Kozek-Langenecker S A. Lokoregionalanästhesie und Blutgerinnung. Behandlung mit Thrombozytenfunktionshemmern.  Anaesthesist. 2003;  52 549-562
    CrossrefPubMedSearch in Google Scholar
  • 18 Leese P, Hubbard R, Karim A, Isakson P C, Yu S S, Geis G S. Effects of celcoxib, a novel cyclooxygenase-2 inhibitor, on platelet function in healthy adults: a randomized, controlled trial.  J Clin Pharmacol. 2000;  40 124-132
    CrossrefPubMedSearch in Google Scholar
  • 19 Gajraj N M. Cyclooxygenase-2 inhibitors.  Anesth Analg. 2003;  96 1720-1738
    PubMedSearch in Google Scholar
  • 20 Gogarten W, van Aken H, Büttner J, Riess H, Wulf H, Buerkle H. Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation.  Anaesth Intensivmedizin. 2003;  44 218-230
    PubMedSearch in Google Scholar
  • 21 Kövesi T, Royston D. Is there a bleeding problem with platelet-active drugs?.  Br J Anaesth. 2002;  88 159-163
    CrossrefPubMedSearch in Google Scholar
  • 22 Chun R, Orser B A, Madan M. Platelet glycoprotein IIb/IIIa inhibitors: overview and implications for the anaesthesiologist.  Anesth Analg. 2002;  95 879-888
    PubMedSearch in Google Scholar
  • 23 Calenda E, Papion H, Borg J Y, Menguy E, Delaunay T, Watelet J, Testart J, Winkler C. Correction of bleeding time after administration of desmopressin in a woman treated with ticlopidine.  Presse Med 1988 Nov. 12;  17 2143
    PubMedSearch in Google Scholar
  • 24 Wilde M, Markham A. Danaparoid: A review of its pharmacology and clinical use in the management of heparin-induced thrombocytopenia.  Drugs. 1997;  54 903-924
    PubMedSearch in Google Scholar
  • 25 Lipp H P. Fondaparinux - ein synthetischer Faktor-Xa-Inhibitor.  Krankenhauspharmazie. 2002;  23 141-148
    PubMedSearch in Google Scholar
  • 26 Eriksson B I, Bergqvist D, Kälebo P, Dahl O E, Lindbratt S, Bylock A, Frison L, Eriksson U G, Welin L, Gustafsson D. Ximelagatran and megalatran compared with dalteparin for the prevention of venous thromboembolism after total hip or knee replacement. The METHRO II randomised trial.  Lancet. 2002;  360 1441-1447
    CrossrefPubMedSearch in Google Scholar
  • 27 Gustafsson D, Nyström J, Carlsson S. The direct thrombin inhibitor melagatran and its oral prodrug H 376/95: intestinal absorption, biochemical and pharmacodynamic effects.  Thromb Res. 2001;  101 171-181
    CrossrefPubMedSearch in Google Scholar
  • 28 Johansson L C, Frison L, Logren U, Fager G, Gustafsson D, Eriksson U G. Influence of the age on the pharmacokinetics and pharmacodynamics of ximelagatran, an oral direct thrombin inhibitor.  Clin Pharmacokinet. 2003;  42 382-392
    PubMedSearch in Google Scholar
  • 29 Pindur G, Ziegeler S, Kleinschmidt S. Melagatran und Ximelagatran. Pharmakologische Eigenschaften und anästhesiologische Aspekte.  Anaesthesist. 2003;  52 1171-1175
    CrossrefPubMedSearch in Google Scholar
  • 30 Pravinkumar E, Webster N R. HIT/HITT and alternative anticoagulation: current concepts.  Brit J Anaesth. 2003;  90 676-685
    PubMedSearch in Google Scholar
  • 31 Ang-Lee M K, Moss J, Yuan C S. Herbal medicines and perioperativen care.  JAMA. 2001;  286 208-216
    CrossrefPubMedSearch in Google Scholar
  • 32 Cheng B, Hung C T, Chiu W. Herbal medicine and anaesthesia.  HKMJ. 2002;  8 123-130
    PubMedSearch in Google Scholar
  • 33 Smith P F, Maclennan K, Darlington C L. The neuroprotective properties of the Gingko biloba leaf: a review of the possible relationship to platelet-activating factor (PAF).  J Ethnopharmacol. 1996;  50 131-139
    CrossrefPubMedSearch in Google Scholar
  • 34 German K, Kumar U, Blackford H N. Garlic and the risk of TURP bleeding.  Br J Urol. 1995;  76 518
    PubMedSearch in Google Scholar
  • 35 Backon J. Ginger: inhibition of thromboxane synthetase and stimulation of prostacyclin: relevance for medicine and psychiatry.  Med Hypotheses. 1986;  20 271-278
    PubMedSearch in Google Scholar
  • 36 Yu C M, Chan J C, Sanderson J E. Chinese herbs and warfarin potentiation by „danshen”.  J Intern med. 1997;  241 337-339
    CrossrefPubMedSearch in Google Scholar
  • 37 Page R L 2nd , Lawrence J D. Potentiation of warfarin by dong quai.  Pharmacotherapy. 1999;  19 870-876
    CrossrefPubMedSearch in Google Scholar
  • 38 Janetzky K, Morreale A P. Probable interactions between warfarin and ginseng.  Am J Health Syst Pharm. 1997;  54 692-693
    PubMedSearch in Google Scholar
  • 39 Bone R C. Modulators of coagulation. A critical appraisal of their role in sepsis.  Arch Intern Med. 1992;  152 1381-1389
    CrossrefPubMedSearch in Google Scholar
  • 40 Holmsen H. Biochemistry and function of platelets. Composition of platelets. In: Williams WJ, Beutler E, Erslev AJ, Lichtman MA (Hrsg) Hematology. New York; McGraw Hill 1991: 1182-1200
    Search in Google Scholar
  • 41 Ehrman M E, Jaffe E A. Prostacyclin (PGI2) inhibits the development in human platelets of ADP and arachidonic acid - induced shape change and procoagulant activity.  Prostaglandins. 1980;  20 1103-1116
    CrossrefPubMedSearch in Google Scholar
  • 42 Osterud B, Rapaport S I. Activation of factor IX by the reaction product of tissue factor and factor VII: additional pathway for initiating blood coagulation.  Proc Natl Acad Sci USA. 1977;  74 5260-5264
    CrossrefPubMedSearch in Google Scholar
  • 43 Zur M, Nemerson Y. Kinetics of factor IX activation via the extrinsic pathway. Dependence of Km on tissue factor.  J Biol Chem. 1980;  255 5703-5707
    PubMedSearch in Google Scholar
  • 44 Edwards E L, Rickles F R. The role of leucocytes in the activation of blood coagulation.  Semin Hematol. 1992;  29 202-212
    PubMedSearch in Google Scholar
  • 45 Archipoff G, Beretz A, Freyssinet J M. Heterogeneous regulation of constitutive thrombomodulin or inducible tissue-factor activities on the surface of human saphenous-vein endothelial cells in culture following stimulation by interleukin-1, tumour necrosis factor, thrombin or phorbol ester.  Biochem J. 1991;  273 679-684
    PubMedSearch in Google Scholar
  • 46 Stern E M, Esposito C, Gerlach H, Gerlach M, Ryan J, Handley D, Nawroth P. Endothelium and regulation of coagulation.  Diabetes Care. 1991;  14 160-166
    PubMedSearch in Google Scholar
  • 47 Okajima K, Wang Y P, Okabe H, Inoue M, Takatsuki K. Role of leucocytes in the activation of intravascular coagulation in patients with septicemia.  Am J Hematol. 1991;  36 265-271
    PubMedSearch in Google Scholar
  • 48 Altieri D C, Morrissey J H, Edgington T S. Adhesive receptor Mac-1 coordinates the activation of factor X on stimulated cells of monocytic and myeloid differentiation: an alternative initiation of the coagulation protease cascade.  Proc Natl Acad Sci USA. 1988;  85 7462-7466
    PubMedSearch in Google Scholar
  • 49 Lentz S R, Tsiang M, Sadler J E. Regulation of thrombomodulin by tumor necrosis factor-α: comparison of transcriptional and posttranscriptional mechanisms.  Blood. 1991;  77 542-550
    PubMedSearch in Google Scholar
  • 50 Moore K L, Andreoli S P, Esmon N L, Esmon C T, Bang N U. Endotoxin enhances tissue factor and suppresses thrombomodulin expression of human vascular endothelium in vitro.  J Clin Invest. 1987;  79 124-130
    CrossrefPubMedSearch in Google Scholar
  • 51 Sakata Y, Curriden S, Lawrence D, Griffin J H, Loskutoff D J. Activated protein C stimulates the fibrinolytic activity of cultured endothelial cells and decreases antiactivator activity.  Proc Natl Acad Sci USA. 1985;  82 1121-1125
    PubMedSearch in Google Scholar
  • 52 Mann K G. Membrane-bound enzyme complexes in blood coagulation. In: Spaet TH (Hrg) Progress in Hemostasis and Thrombosis. New York; Grune & Stratton 1994: 1-23
    Search in Google Scholar
  • 53 Horie S, Ishii H, Kazama M. Heparin-like glycosaminoglycan is a receptor for antithrombin III - dependent but not thrombin - dependent prostacyclin production in human endothelial cells.  Thromb Res. 1990;  59 895-904
    CrossrefPubMedSearch in Google Scholar
  • 54 Vane J R, Änggard E E, Botting R M. Regulatory functions of the vascular endothelium.  N Engl J Med. 1990;  323 27-36
    PubMedSearch in Google Scholar
  • 55 Walker F J, Fay P J. Regulation of blood coagulation by the protein C system.  FASEB J. 1992;  6 2561-2567
    PubMedSearch in Google Scholar
  • 56 Scherer R. Gerinnung. In: Kochs E, Krier C, Buzello W, Adams HA (Hrsg) Anästhesiologie. 1. Aufl. Stuttgart; Thieme 2001: 143-149
    Search in Google Scholar
  • 57 Scherer R. Plasmatische Gerinnungsstörungen mit Blutungsneigung. In: Van Aken, Reinhart K, Zimpfer M (Hrsg) Intensivmedizin. 1. Aufl. Stuttgart; Thieme 2001: 589-595
    Search in Google Scholar
  • 58 Scherer R U, Spangenberg P. Procoagulant activity in patients with isolated severe head trauma.  Crit Care Med. 1998;  26 49-156
    PubMedSearch in Google Scholar
  • 59 Pivalizza E G. Perioperative use of the thrombelastograph in patients with inherited bleeding disorders.  J Clin Anesth. 2003;  15 366-370
    CrossrefPubMedSearch in Google Scholar
  • 60 Leslie K, Sessler D I. Perioperative hypothermia in the high-risk surgical patient.  Best Pract Res Clin Anaesthesiol. 2003;  17 485-498
    CrossrefPubMedSearch in Google Scholar
  • 61 Baudo F, de Gasperi A, de Cataldo F. et al . Antithrombin III supplementation during orthotopic liver transplantation in cirrhotic patients: a randomized trial.  Thromb Res. 1992;  68 409-416
    CrossrefPubMedSearch in Google Scholar
  • 62 Langley P G, Hughes R D, Forbes A. et al . Controlled trial of antithrombin III supplementation in ful-minant hepatic failure.  J Hepatol. 1993;  17 326-331
    CrossrefPubMedSearch in Google Scholar
  • 63 Schipper H G, Ten Cate J W. Antithrombin III transfusion in patients with hepatic cirrhosis.  Br J Haematol. 1982;  52 25-33
    PubMedSearch in Google Scholar
  • 64 Lechner K, Kyrle P A. Antithrombin III concentrates - are they clinically useful?.  Thromb Haemostas. 1995;  73 340-348
    PubMedSearch in Google Scholar
  • 65 Heinemann H, Schramm W, Hoffmann P, Lierz P. Multiorganversagen nach Gabe von PPSB beim isolierten Faktor VII-Mangel.  Anästh Intensivmed. 1993;  34 130-133
    PubMedSearch in Google Scholar
  • 66 Yu M, Nardella A, Pechet L. Screening tests of disseminated intravascular coagulation: guidelines for rapid and specific laboratory diagnoses.  Crit Care Med. 1980;  28 1777-1780
    PubMedSearch in Google Scholar
  • 67 Schroeder S, Wichers M, Lier H. Diagnostik und Therapie von komplexen Gerinnungsstörungen in der operativen Intensivmedizin.  Anaesth Intensivmedizin. 2003;  44 668-679
    PubMedSearch in Google Scholar
  • 68 Scherer R, Paar D, Stöcker L, Kox W. Diagnose und Therapie pathologischer Gerinnungsaktivierungen.  Anästhesist. 1994;  43 347-354
    PubMedSearch in Google Scholar
  • 69 Arbeitsgemeinschaft der Bundesärztekammer. Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. 2. Aufl. Köln; Deutscher Ärzteverlag Köln 2001
    Search in Google Scholar
  • 70 König H, Hanker-Dusel C, Eich S, Grundmann C, Seitz R. The thrombogenetic agent in prothrombin complex concentrates (PCC): Identification of elevated levels of prothrombin as the major cause.  Thromb Haemost. 2003;  90 Suppl 1 S16-S48
    PubMedSearch in Google Scholar
  • 71 Scherer R U. Hämostaseologische Aspekte des perioperativen Blutmanagements.  Zentralbl Chir. 2003;  128 473-480
    Thieme ConnectPubMedSearch in Google Scholar
  • 72 Gerlach R, Tolle F, Raabe A, Zimmermann M, Siegemund A, Seifert V. Increased risk for postoperative hemorrhage after intracranial surgery in patients with decreased factor XIII activity: implications of a prospective study.  Stroke. 2002;  33 1618-1623
    CrossrefPubMedSearch in Google Scholar
  • 73 Hoffman M, Monroe III D M. A cell-based model of hemostasis.  Thromb Haemost. 2001;  85 958-965
    PubMedSearch in Google Scholar
  • 74 Heuer L, Blumenberg D. Rekombinanter Faktor VIIa. Ein Überblick über aktuelle und mögliche zukünftige Indikationen.  Anaesthesist. 2002;  51 388-399
    PubMedSearch in Google Scholar
  • 75 Monroe D M, Hoffmann M, Oliver J A, Roberts H R. Platelet activity of high-dose factor VIIa is independent of tissue factor.  Br J Haematol. 1997;  99 542-547
    CrossrefPubMedSearch in Google Scholar
  • 76 Mannucci P M. Hemostatic drugs.  N Engl J Med. 1998;  339 245-253
    PubMedSearch in Google Scholar
  • 77 Levi M, Cromheecke M E, de Jonge E, Prins M H, de Mol B J, Briet E, Buller H R. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints.  Lancet. 1999;  354 1940-1947
    CrossrefPubMedSearch in Google Scholar
  • 78 Ozal E, Kuralay E, Bingol H, Cingoz F, Ceylan S, Tatar H. Does tranexamic acid reduce desmopressin-induced hyperfibrinolysis?.  J Thorac Cardiovasc Surg. 2002;  123 539-543
    CrossrefPubMedSearch in Google Scholar
  • 79 Scherer R, Ostermann H, Forst H, Eckart J. Die postoperative Blutung.  Anaesthesiologie Intensivmedizin. 1999;  11 786-788
    PubMedSearch in Google Scholar

Prof. Dr. med. R. U. Scherer

Zentrale Abteilung für Anästhesiologie und Intensivmedizin
Evangelisches und Johanniter Klinikum Duisburg/Dinslaken/Oberhausen gGmbH

Fahrner Straße 133 - 135
47169 Duisburg

Email: ralf.scherer@ejk.de