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Phlebologie 2016; 45(04): 215-218
DOI: 10.12687/phleb2315-4-2016
DOI: 10.12687/phleb2315-4-2016
Review article
Venöse Thromboembolie im Alter
Article in several languages: English | deutschAuthors
Further Information
Publication History
Received:
08 June 2016
Accepted:
10 June 2016
Publication Date:
21 December 2017 (online)
Zusammenfassung
Alter ist ein unabhängiger Risikofaktor der venösen Thromboembolie. Die Symptomatik wird bei betagten und geriatrischen Patienten oft als Ausdruck der bestehenden, insbesondere kardiopulmonalen Komorbidität gedeutet. Wenn man aber die Möglichkeit einer venösen Thromboembolie (VTE) ins Auge fasst, deutet die Synopse der bestehenden Beschwerden und anamnestischen Informationen (systematisch evaluiert z.B. im Wells-Score) oft dennoch auf die Diagnose. Die sekundärprophylaktische Behandlung besteht in der therapeutischen Antikoagulation durch Vitamin-K-Antagonisten oder orale, direkt wirksame Antikoagulanzien (DOAK). In beiden Fällen ist strikte Compliance des Patienten oder des Betreuenden essenziell. Ein Hauptaugenmerk ist zu richten auf ein im Alter deutlich gesteigertes Blutungsrisiko durch die gleichzeitige Einnahme von Thrombozytenaggregationshemmern oder nicht-steroidaler Antirheumatika, oft auch durch unbekannte Eigenmedikation. Bei Notwendigkeit einer langfristigen Antikoagulationstherapie kann die Strategie einer dosisgeminderten Fortführung erwogen werden, insbesondere bei gesteigertem Blutungsrisiko.
Eine systemische Fibrinolyse bei Lungenembolie geht bei betagten Patienten mit einem sehr hohen Blutungsrisiko einher. Sie sollte lediglich bei Kreislaufdepression mit vitaler Indikation, nicht aber bei isolierten Zeichen der Rechtsherzbelastung erfolgen.
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References
- 1 Silverstein M, Heit J, Mohr D. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585-593.
- 2 Longo MG, Greco A, Pacilli M, D’Ambrosio LP, Scarcelli C, Grandone E, Fanelli R, Di Minno G, Pilotto A. Deep venous thrombosis in elderly hospitalized patients: prevalence and clinical features. Aging Clin Exp Res 2005; Feb; 17 (01) 42-45.
- 3 Anderson Jr FA, Wheeler HB, Goldberg RJ. et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 1991; 151: 933-938.
- 4 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 1999; 159: 445-453.
- 5 Heit JA, Mohr DN, Silverstein MD, Petterson TM, O’Fallon WM, Melton LJ. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000; 160: 761-768.
- 6 Lopez-Jimenez L, Montero M, Gonzalez-Fajardo JA. et al. RIETE Investigators. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Haematologica 2006; 91: 1046-1051.
- 7 Bosson JL, Labarere J, Sevestre MA, Belmin J, Beyssier L, Elias A, Franco A, Le Roux P. Deep vein thrombosis in elderly patients hospitalized in subacute care facilities: a multicenter cross-sectional study of risk factors, prophylaxis, and prevalence. Arch Intern Med 2003; 163: 2613-2618.
- 8 Prandoni P, Lensing A, Cogo A. et al. The longterm clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1-7.
- 9 Folsom AR, Boland LL, Cushman M, Heckbert SR, Rosamond WD, Walston JD. Frailty and risk of venous thromboembolism in older adults. JGerontol A Biol Sci Med Sci 2007; 62: 79-82.
- 10 Di Nisio MI, Di Iorio A, Porreca E, Abate M, Ferrante N, Bandinelli S, Guralnik J, Molino-Lova R, Cuccurullo F, Ferrucci L. Obesity, poor muscle strength, and venous thromboembolism in older persons: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2011; Mar; 66 (03) 320-325 doi: 10.1093/gerona/glq207. Epub 2010 Nov 26.
- 11 Reiner API, Lange LA, Smith NL, Zakai NA, Cushman M, Folsom AR. Common hemostasis and inflammation gene variants and venous thrombosis in older adults from the Cardiovascular Health Study. J Thromb Haemost 2009; Sep; 07 (09) 1499-1505.
- 12 Morel O, Toti F, Hugel B. et al. Procoagulant microparticles: disrupting the vascular homeostasis equation?. Arterioscler Thromb Vasc Biol 2006; 26: 2594-2604.
- 13 Oger E, Bressollette L, Nonent M, Lacut K, Guias B, Couturaud F, Leroyer C, Mottier D. High prevalence of asymptomatic deep vein thrombosis on admission in a medical unit among elderly patients. Thromb Haemost 2002; Oct; 88 (04) 592-597.
- 14 Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Haemost 2007; Jul. 05 (Suppl. 01) 41-50.
- 15 AWMF-S2-Leitlinie: Diagnostik und Therapie der Venenthrombose und der Lungenembolie Aktueller Stand: 10. Oktober. 2015 AWMF Leitlinien- Register Nr. 065/002..
- 16 Timmons SI, Kingston M, Hussain M, Kelly H, Liston R. Pulmonary embolism: differences in presentation between older and younger patients. Age Ageing 2003; Nov; 32 (06) 601-605.
- 17 Tita-Nwa F, Bos A, Adjei A, Ershler WB, Longo DL, Ferrucci L. Correlates of D-dimer in older persons. Aging Clin Exp Res 2010; Feb; 22 (01) 20-23.
- 18 Gatt ME, Paltiel O, Bursztyn M. Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historical-cohort study. Thromb Haemost 2004; Mar; 91 (03) 538-543.
- 19 Kohsytorz A, Kolb G. Thromboembolierisiko und Gerinnungsaktivierung bei immobilisierten Pflegeheimbewohnern. Euro J Ger 2001; 03: 146-152.
- 20 AWMF-S3-Leitlinie: Prophylaxe der venösen Thromboembolie (VTE); 2. komplett überarbeitete Auflage, Stand: 15.10.2015. Leitlinien- Register 003/001..
- 21 Gladstone DJ, Bui E, Fang J, Laupacis A, Lindsay MP, Tu JV, Silver FL, Kapral MK. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 2009; Jan; 40 (01) 235-240.
- 22 Spencer FA, Gore JM, Lessard D. et al. Venous thromboembolism in the elderly. A communitybased perspective. Thromb Haemost 2008; Nov; 100 (05) 780-788.
- 23 Johnsen SP, Sørensen HT, Mellemkjoer L, Blot WJ, Nielsen GL, McLaughlin JK. et al. Hospitalisation for upper gastrointestinal bleeding associated with use of oral anticoagulants. Thromb Haemost 2001; 86: 563-8.
- 24 Hart RG, Benavente O, Pearce LA. Increased risk of intracranial hemorrhage when aspirin is combined with warfarin: a meta-analysis and hypothesis. Cerebrovasc Dis 1999; 09: 215-217.
- 25 Siebenhofer A, Rakovac I, Kleespies C, Piso B, Didjurgeit U. SPOG 60+ Study Group. Self-management of oral anticoagulation reduces major outcomes in the elderly. A randomized controlled trial. Thromb Haemost 2008; Dec; 100 (06) 1089-1098.
- 26 Insam C, Méan M, Limacher A, Angelillo-Scherrer A, Aschwanden M, Banyai M. et al. Anticoagulation Management Practices and Outcomes in Elderly Patients with Acute Venous Thromboembolism: A Clinical Research Study. PLoS ONE 2016; 11 (02) e0148348 doi:10.1371/journal. pone.0148348.
- 27 Meyer G, Vicaut E, Danays T. et al. for the PEITHO Investigators. Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism. N Engl J Med 2014; 370: 1402-1411.
- 28 Sharma M, Cornelius VR, Patel JP, Davies JG, Molokhia M. Efficacy and Harms of Direct Oral Anticoagulants in the Elderly for Stroke Prevention in Atrial Fibrillation and Secondary Prevention of Venous Thromboembolism: Systematic Review and Meta-Analysis. Circulation 2015; Jul 21; 132 (03) 194-204 doi: 10.1161/CIRCULATIONAHA.114.013267. Epub 2015 May 20.
- 29 Ridker PM. et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348: 1425-1434.
- 30 Kearon C, Ginsberg JS, Konvacs MJ, et al. Comparison of low-intenity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003; 349: 631-639.
- 31 Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, Porcari A, Raskob GE, Weitz JI. PLIFY-EXT Investigator. Apixaban for extended treatment of venous thromboembolism. N Engl J Med 2013; Feb 21; 368 (08) 699-708 doi: 10.1056/NEJMoa1207541. Epub 2012 Dec 8.
- 32 Weitz JI, Bauersachs R, Beyer-Westendorf J, Bounameaux H, Brighton TA, Cohen AT, Davidson BL, Holberg G, Kakkar A, Lensing AW, Prins M, Haskell L, van Bellen B, Verhamme P, Wells PS, Prandoni P. EINSTEIN CHOICE Investigators. Two doses of rivaroxaban versus aspirin for prevention of recurrent venous thromboembolism. Rationale for and design of the EINSTEIN CHOICE study. Thromb Haemost 2015; 114 (03) 645-650 doi: 10.1160/TH15-02-0131. Epub 2015 May 21.