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Radiologie up2date 2013; 13(03): 261-273
DOI: 10.1055/s-0033-1344382
Neuroradiologie
© Georg Thieme Verlag KG Stuttgart · New York

Antikoagulanzien – Grundlage, Wirkungsweise

Anticoagulation treatment – basic principles and mechanisms of action
S. Langner
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Publication History

Publication Date:
01 September 2013 (online)

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Zusammenfassung

Das periinterventionelle Gerinnungsmanagement in der interventionellen Radiologie ist aufgrund der Vielzahl an Interventionen sowie der zur Verfügung stehenden Medikamente komplex. Es werden die Grundlagen der Blutgerinnung sowie die verschiedenen Medikamente, die sie beeinflussen können, und deren Wirkmechanismen dargestellt. Empfehlungen für die Anwendung in der klinischen Routine werden präsentiert.

Abstract

Hematologic management in patients undergoing endovascular or image-guided interventions is complex because of the different kind of procedures and wide range of therapeutics. Basic principles of coagulation and anticoagulation treatment are described. Guidelines for clinically routine work up are presented.

Kernaussagen

  • Gerinnungshemmende Medikamente können entweder über eine Beeinflussung der Thrombozytenfunktion oder durch Beeinflussung der Blutgerinnung wirksam werden.

  • Eine periinterventionelle Vollheparinisierung sollte mit unfraktioniertem Heparin erfolgen. Postinterventionell kann diese auf niedermolekulares Heparin umgestellt werden.

  • Die gefürchtetste Komplikation der Heparintherapie ist die heparininduzierte Thrombozytopenie Typ II. Bereits bei klinischem Verdacht muss die Heparintherapie beendet werden.

  • ASS und Clopidogrel bilden die Grundlage der dualen Thrombozytenaggregationshemmung und dienen zum Schutz vor thrombembolischen Komplikationen nach Angioplastie oder Stentimplantation.

  • Glykoprotein-IIb/IIIa-Rezeptorantagonisten dienen vor allem zur Behandlung periinterventioneller thrombembolischer Komplikationen und sollten nur unter intensivmedizinischer Überwachung verwendet werden.

  • In zweifelhaften Fällen ist es zwingend notwendig, sich mit einem Gerinnungsmediziner abzustimmen, um eine Gefährdung des Patienten zu verhindern.

Keywords

Coagulation - anticoagulation treatment - interventional radiology
 

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