Sekundärprophylaxe der venösen Thromboembolie

Zusammenfassung

Die Behandlung der akuten venösen Thromboembolie ist weitgehend standardisiert, effektiv und sicher. Die Prävention von Rezidiven ist dies nicht. Die Antikoagulation verhindert Rezidive zuverlässig, ist aber mit erheblichen Blutungsgefahren vergesellschaftet. Nach Absetzen der Antikoagulation drohen Rezidive in 0 bis >20% der Fälle. Ein relativ niedriges Risiko besteht, wenn es sich um eine sekundäre Thrombose handelt, die auslösende Ursache nicht weiter besteht, die Therapie schnell und korrekt erfolgte, keine Thrombusreste mehr vorhanden sind und die D-Dimer- Konzentration im Referenzbereich liegt. Ein hohes Rezidivrisiko liegt vor, wenn die tiefe Venenthrombose idiopathisch war oder in Zusammenhang stand mit einem Krebsleiden oder einem Antikörper im Gerinnungssystem. Eine etwas geringere Rolle spielt das eventuelle Vorhandensein einer molekularen Thrombophilie. Strategien zur Vermeidung von Rezidiven werden aufgezeigt.

Summary

The management of acute deep vein thrombosis is standardized, effective and safe. The prevention of recurrences is much less established. Anticoagulant treatment reliably prevents recurrence but is associated with a considerable risk of bleeding. After discontinuation of anticoagulant therapy recurrences occur with a frequency between 0 and >20%. A relatively modest risk is observed if the deep vein thrombosis was secondary to a transient condition, if therapy was started rapidly and correctly, if the thrombi had completely disappeared, and the D-dimer concentration is within the reference range. A relatively high risk of recurrence is associated with an idiopathic origin of the deep vein thrombosis, active cancer or an antibody in the coagulation system. Of less importance is the eventual presence of a genetic thrombophilia. Possible strategies for avoidance of recurrences are discussed.

Résumé

Le traitement de la thrombose veineuse (TVP) aiguë est standardisé, effectif et sûr. La prévention des récidives est moins bien établie. Le traitement aux anticoagulants prévient des récidives avec une haute certitude mais est associé à un risque considérable d’hémorragies sévères. Après la discontinuation de l’anticoagulation on observe des récidives avec une fréquence entre 0 et >20%. Un risque relativement faible est présent s’il s’agit d’une TVP secondaire à un événement transitoire, si le traitement a été exécuté correctement, si les cailloux ont complètement disparus et le taux des D-dimères est normalisé. Le risque de récidives est relativement élevé si la TVP était idiopathique de nature, associée avec un cancer ou un anticorps dans le système de l’hémostase. La présence d’une éventuelle thrombophilie moléculaire y joue un moindre rôle. Le rapport discute des stratégies utile à réduire les risques de récidives avec un minimum d’effort et de coûts.

Schlüsselwörter

Venöse Thromboembolie - Rezidivprophylaxe

Keywords

Deep-vein thrombosis - prevention of recurrence

Mots clés

Thrombose veineuse profonde - prévention de récidives

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