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Zentralbl Chir 2014; 139(S 01): S13-S21
DOI: 10.1055/s-0034-1382895
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Perioperativer Umgang mit Antikoagulanzien und Thrombozytenaggregationshemmern in der Thoraxchirurgie

Perioperative Anticoagulant and Antiplatelet Treatment in General Thoracic Surgery
J. Schnell
1   Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie, Kliniken der privaten Universität Witten-Herdecke, Deutschland
,
A. Koryllos
1   Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie, Kliniken der privaten Universität Witten-Herdecke, Deutschland
,
E. Stoelben
1   Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie, Kliniken der privaten Universität Witten-Herdecke, Deutschland
,
B. Schlößer
2   Institut für Transfusionsmedizin, Kliniken der privaten Universität Witten-Herdecke, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
29 September 2014 (online)

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Zusammenfassung

Der perioperative Umgang mit antikoagulatorischen Substanzen in der Thoraxchirurgie ist ein „zweischneidiges Schwert“: Das Bestreben, einerseits das thrombembolische Risiko im arteriellen und venösen Gefäßsystem zu minimieren, steht im Gegensatz zu dem Ziel der intra- und postoperativen Blutungsvermeidung. Aufgrund dispositioneller Risikofaktoren wie Nikotinabusus bieten die thoraxchirurgischen Patienten häufig kardiovaskuläre Komorbiditäten, die eine antikoagulative oder antithrombozytäre Therapie notwendig machen. In der Thromboseprophylaxe, im perioperativen Umgang mit Vitamin-K-Antagonisten und Plättchenaggregationshemmern hat sich die Erstellung von individuellen Risikoprofilen mit Einteilung in verschiedene Risikoklassen bewährt. Mit deren Hilfe können Behandlungspläne zu perioperativer antikoagulatorischer Therapie entworfen werden, die den Patienten bestmöglich auf dem Grat zwischen Blutung und Thrombembolie führen. Für die neuen oralen Antikoagulanzien existieren bislang zu wenig Daten, um evidenzbasierte Empfehlungen zur perioperativen Therapieumstellung zu geben. Algorithmen werden vorgeschlagen, welche die verschiedenen Facetten antikoagulatorischer Therapie berücksichtigen.

Abstract

The perioperative use of anticoagulants in general thoracic surgery can be considered to be a “two-edged sword”: the goal to minimise the risk of a thromboembolic episode is contrary to the ongoing effort of the surgeon to minimise the risk of intra- and postoperative blood loss. Dispositional factors such as excessive tobacco use are common for thoracic surgery patients and often lead to cardiovascular comorbidity which necessitates the use of anticoagulants or antiplatelet drugs. For deep venous thrombosis prophylaxis and for the indication and use of vitamin K antagonists or antiplatelet drugs it is proven in the literature that the risk profile of the patient and his/her classification in the appropriate risk group are of major importance. Through the individual risk profile of the patient it is possible to plan the appropriate perioperative anticoagulant therapy which will safely assist the surgeon and his/her patient during the peri- and postoperative phase on the knife-edge between blood loss and eminent thromboembolism. Unfortunately there are not enough existing data and published literature for evidence-based guidelines referring to the correct perioperative management for the new oral anticoagulants. Management algorithms are being recommended according to the multiple aspects of anticoagulant-treatment.

Schlüsselwörter

Thromboseprophylaxe - Vitamin-K-Antagonisten - Thrombozytenaggregationshemmung - perioperatives Bridging - Thoraxchirurgie - NOAK

Key words

thromboprophylaxis - vitamin K antagonists - antiplatelet therapy - perioperative bridging - thoracic surgery - NOAC
 

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