Hyperfibrinolyse nach Reanimation bei akuter Lungenarterienembolie

Zusammenfassung

Kommt es nach einer Reanimation – z. B. wegen akuter Lungenarterienembolie – im Rahmen eines Post-Cardiac-Arrest-Syndroms (PCAS) zu einer Hyperfibrinolyse, stellt dies eine diagnostische und therapeutische Herausforderung dar. In diesem Fallbericht wird die Pathophysiologie der Koagulopathie bei PCAS beschrieben und der Einsatz antifibrinolytischer Therapie bei Patienten mit thrombotischen Komplikationen wie Lungenarterienembolien diskutiert.

Abstract

In an 81-year-old patient, acute hemodynamic instability requiring resuscitation occurred during an elective transurethral prostate resection. The procedure was ended prematurely and after ROSC a CT diagnosis was carried out, which confirmed the suspected diagnosis of fulminant pulmonary embolism. Anticoagulant therapy with heparin was initiated. About two hours after admission to the intensive care unit, hemorrhage requiring massive transfusion developed, which according to viscoelastometric diagnostics was most likely due to fulminant hyperfibrinolysis. This case report describes the pathophysiology of so-called post-cardiac arrest coagulopathy and discusses the use of antifibrinolytic therapy in patients with thrombotic complications such as pulmonary artery embolism.

Kernaussagen

• Im Rahmen eines Post-Cardiac-Arrest-Syndroms kann es zu gravierenden Gerinnungsstörungen kommen, die unterschiedliche Phänotypen aufweisen können.

• Der in diesem Fallbericht vorgestellte Patient musste aufgrund einer fulminanten Lungenembolie intraoperativ reanimiert werden.

• Unter antikoagulatorischer Therapie mit unfraktioniertem Heparin entwickelte er im Rahmen des PCAS auf der Intensivstation eine DIC mit fibrinolytischem Phänotyp.

• Aufgrund der massiven Hämorrhagie bei fulminanter Hyperfibrinolyse war die Applikation von Tranexamsäure trotz der Lungenembolie unvermeidbar.

• Durch Massivtransfusion von Blutprodukten sowie Gabe von Fibrinogenkonzentrat konnte die Hämostase weiter optimiert werden, sodass die Hämorrhagie sistierte.

• Danach konnte die kontinuierliche Gabe von unfraktioniertem Heparin mit reduzierter Dosierung wieder begonnen werden.

Schlüsselwörter

disseminierte intravasale Gerinnung - Lungenarterienembolie - Hyperfibrinolyse - Tranexamsäure - Post-Cardiac-Arrest-Syndrom

Key words

disseminated intravascular coagulation - pulmonary artery embolism - hyperfibrinolysis - tranexamic acid - post-cardiac arrest syndrome

Publikationsverlauf

Artikel online veröffentlicht:
11. September 2020

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