Bewertung des Rezidivthrombose-risikos venöser Thromboembolien

Summary

Recurrent venous thromboembolism is associated with increased mortality in 5–9% of the patients. On the other hand prolonged anticoagulation can increase the bleeding risk which can also be responsible for an increased mortality. Therefore, it is necessary to validate the recurrence risk of venous thromboembolism on an individual basis.

In this review the most relevant risk factors for recurrent venous thromboembolism are analyzed. Spontaneous thrombosis is associated with significantly increased recurrence rates in comparison to risk associated venous thrombosis. In addition, a positive D-dimer result after stop of anticoagulation, an increased amount of residual thrombus in proximal veins analyzed by compression sonography, a proximal localization of thrombosis, symptomatic pulmonary embolism and male sex are clinically relevant risk factors for increased recurrence rates. While mild thrombophilic defects like heterozygous factor V Leiden mutation are not associated with a clinically relevant recurrence risk, inherited inhibitor deficiencies and the anti-phospholipid-syndrome are known to be responsible for an increased recurrence rate of venous thromboembolism. A new recurrence risk-score (RR-Score) for individual judgement of patients with a first spontaneous venous thrombosis is introduced.

Zusammenfassung

Venöse Rezidivthrombosen können in 5–9% der Patienten tödlich sein. Auf der anderen Seite kann eine unnötig lange Fortsetzung der Antikoagulation zu einem deutlich erhöhten Blutungsrisiko für schwere Blutungen führen, das ebenfalls mit einer erhöhten Mortalität assoziiert sein kann. Daher ist eine individuelle Bewertung des Rezidivthromboserisikos von größter klinischer Relevanz.

In diesem Review sollen daher die wesentlichen Determinanten für ein erhöhtes Rezidivrisiko bewertet werden. Das Rezidivrisiko ist bei Auftreten spontaner venöser Thrombosen wesentlich höher als bei Risiko-assoziierten Thrombosen.Weitere klinisch relevante Determinanten sind ein positiver D-Dimertest nach Beendigung der Antikoagulation, die Restthrombuslast im Bereich proximaler Venen im Kompressionsultraschall, eine proximale Lokalisation der Thrombose, das Auftreten einer klinisch symptomatischen Lungenembolie und das männliche Geschlecht. Milde thrombophile Neigungen wie z. B. die heterozygote Faktor-V-Leiden-Mutation spielen keine wesentliche Rolle für das Rezidivthromboserisiko, wogegen angeborene Inhibitormängel und das Antiphospholipid-Syndrom mit einem deutlich erhöhten Rezidivrisiko assoziiert sind. Abschließend wird ein neuer Rezidiv-Risiko-Score (RR-Score) zur individuellen Bewertung des Rezidivrisikos bei Patienten mit spontaner Erstthrombose vorgestellt.

Keywords

Venous thromboembolism

Schlüsselwörter

Venöse Rezidivthrombose

• Literatur

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