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DOI: 10.1055/s-2006-944543
Verbrauchskoagulopathie - disseminierte intravasale Gerinnung
Publikationsverlauf
Publikationsdatum:
30. August 2006 (online)
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Kernaussagen
Die disseminierte intravasale Gerinnung/Verbrauchskoagulopathie ist eine schwerwiegende Komplikation verschiedener Grunderkrankungen.
Die Begriffe „disseminierte intravasale Gerinnung” und „Verbrauchskoagulopathie” beschreiben unterschiedliche Aspekte einer zunehmenden Hämostaseaktivierung, welche klinisch vor allem als hämorrhagische Diathese und/oder Organdysfunktion in Erscheinung tritt.
Die Hämostaseaktivierung mit überschießender Thrombinbildung führt zu den wesentlichen Faktoren des Scoring-Systems: Fibrinogenabfall, Thrombozytopenie, Quick-Wert-Abfall (Prothrombinzeitverlängerung) und Erhöhung der Fibrinspaltprodukte (D-Dimere). Zur Verlaufskontrolle und Einordnung der disseminierten intravasalen Gerinnung ist zusätzlich die Dynamik der Veränderung der Gerinnungsinhibitoren (insbesondere Antithrombin und Protein C) wichtig. Danach unterscheidet man eine kompensierte von einer dekompensierten disseminierten intravasalen Gerinnung.
Im Zentrum der Behandlung steht die Erkennung und kausale Therapie der Grunderkrankung sowie bei akut dekompensierten DIG-Patienten die Aufrechterhaltung und Sicherstellung der Vitalfunktionen. Die Hemmung der überschießenden Thrombinbildung durch Antikoagulanzien und Gerinnungsinhibitoren steht gleichberechtigt neben der Wiederherstellung eines ausreichenden Hämostasepotenzials, insbesondere durch Gabe von gefrorenem Frischplasma.
Die Empfehlungen zum praktischen Vorgehen basieren überwiegend auf Erfahrungswerten. Lediglich für Patienten mit Hämostasestörungen bei schwerer Sepsis liegen prospektiv randomisierte Studien zur Bedeutung einer prophylaktischen Heparintherapie und zur therapeutischen Gabe von Gerinnungsinhibitoren vor. Dabei hat sich nur die Gabe von APC als wirksames, mortalitätssenkendes und gleichzeitig sicheres Therapieprinzip erwiesen.
Regelmäßige Laborkontrollen zur Entwicklung der Grundkrankheit und den Hämostaseveränderungen erlauben eine individuelle Optimierung der hämostasemodulierenden Behandlung.
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Dr. med. Ralf Trappe
Charité Universitätsmedizin Berlin
Campus Virchow-Klinikum · Medizinische Klinik m. S. Hämatologie und Onkologie · Augustenburger Platz 1 · 13353 Berlin
Telefon: 0 30/45 05 53-5 10
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eMail: ralf_ulrich.trappe@charite.de