Erworbene schwere Gerinnungsstörung

Blutungen bei erworbenen komplexen Gerinnungsstörungen wie disseminierter intravasaler Gerinnung, Trauma-induzierter oder hepatischer Koagulopathie sind eine hämotherapeutische Herausforderung. Entscheidend für ein erfolgreiches Blutungsmanagement sind die frühe Erkennung der vorliegenden Gerinnungsstörung und eine zielgerichtete Therapie mittels Blutkomponenten, Faktorenkonzentraten und anderer Maßnahmen.

Abstract

Blood loss, consumption or impaired synthesis can lead to a reduction in platelets and plasmatic coagulation factors in various disease conditions. This can result in severe bleeding, for example in disseminated intravascular coagulation (DIC) or trauma-induced coagulopathy (TIC). Bleeding management in these conditions is challenging due to the fact that anticoagulant hemostasis components are usually also reduced and fibrinolytic mechanisms are impaired. Therefore, thrombotic complications can also be prominent features. In addition to clinical pictures such as DIC and TIC, complex coagulation disorders can also develop less acute or be present permanently, for example in hepatic coagulopathy. The treatment of prothrombotic diseases with antiaggregants and anticoagulants can also trigger or complicate bleeding. A common feature in the management of DIC and TIC is the importance of timely diagnosis of the acquired coagulopathy and a targeted therapeutic approach in case of bleeding. This review article summarizes the main features of laboratory diagnostics and hemotherapy in DIC and TIC and also addresses the special features of hepatic coagulopathy and bleeding under antithrombotic medication.

Schlüsselwörter

disseminierte intravasale Gerinnung - Trauma-induzierte Koagulopathie - hepatische Koagulopathie - Antagonisierung von Antithrombotika

Keyword

disseminated intravascular coagulation - Trauma-induced coagulopathy - hepatic coagulopathy - antithrombotic drug reversal

Publication History

Article published online:
11 February 2025

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