Perioperative Thromboseprophylaxe – Medikamentöse Thromboseprophylaxe in der Intensivmedizin

Zusammenfassung

Intensivmedizinisch betreute Patienten sind regelhaft als Hochrisikopatienten für venöse Thromboembolien einzuschätzen. Jenseits einer grundsätzlichen Empfehlung für eine medikamentöse Prophylaxe aus den Fachgesellschaften liegen aufgrund der unzureichenden Datenlage für dieses Patientenkollektiv keine Richtlinien für die Wahl der Substanz oder der Dosierung vor. Prinzipiell können UFH, NMH und Fondaparinux zur Anwendung kommen. Für Patienten mit akut vermuteter oder gesicherter HIT Typ II kann eine Antikoagulation mit Argatroban sicher fortgeführt werden. Für die neuen oral verfügbaren Antikoagulanzien zeichnet sich gegenwärtig noch kein Einsatzgebiet in der Intensivmedizin ab.

Abstract

Critical care patients have to be considered at high risk patients for thromboembolic events. The recommendations and guidelines support strongly a pharmacologic anticoagulant prophylaxis. Due to the fact that only very few data are available for this selected patient population there are still open questions concerning the ideal choice of drug and optimal dosages. Prophylactic administration of UFH, LMWH and Fondaparinux can be used safely and effectively. In case of acutely suspected or diagnosed HIT type II Argatroban seems to be a reasonable choice for anticoagulation. The new orally available anticoagulant drugs are not yet indicated in ICU patients.

Schlüsselwörter:

Intensivmedizin - kritisch kranke Patienten - venöse Thromboembolie - Prophylaxe - Antikoagulanzien - UFH - NMH - Fondaparinux

Keywords:

ICU - critically ill patients - venous thromboembolism - prophylaxis - anticoagulants - UFH - LMWH - Fondaparinux

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