Gerinnungsstörung bei Zirrhose

Patienten mit terminaler Leberinsuffizienz zeigen im klassischen Labor (Quick, aPTT, Fibrinogen) pathologische Werte, was auf eine Blutungsneigung hinweist. Gemäß aktuellen Daten neigen diese Patienten eher zu Thrombosen als zu Blutungen. Viskoelastische Tests, wie ROTEM oder TEG, liefern eine dynamische Bewertung der Gerinnselbildung im Vollblut – bei der Therapie von Gerinnungsproblemen ein deutlicher Vorteil gegenüber dem Standardlabor.

Kernaussagen

• Patienten mit Leberzirrhose neigen stärker zu Thrombosen als zu Blutungen, sodass eine Thromboseprophylaxe bei Immobilisation erforderlich ist, auch wenn die SLT pathologische Ergebnisse liefern.

• Im Falle einer Pfortaderthrombose können niedermolekulare Heparine eingesetzt werden. Zu den DOAC gibt es aktuell nur wenige Erfahrungsberichte und es muss abgewartet werden, ob sie gegenüber NMH oder Phenprocoumon einen relevanten Vorteil haben.

• Die Gerinnungsdiagnostik und die Therapie sollten anhand von VET (ROTEM oder TEG) erfolgen.

• Das Risiko einer Blutung korreliert nicht mit den Werten der SLT, sondern mit dem portalen Druck. Daher sollten eine Volumentherapie und vor allem der prophylaktische Einsatz von FFP auf jeden Fall unterbleiben.

Schlüsselwörter

Leberinsuffizienz - Hämostase - Blutungsmanagement - Thromboseprophylaxe - viskoelastische Testverfahren

Publication History

Article published online:
08 March 2021

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