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Medizinische Klinik - Intensivmedizin und Notfallmedizin

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05.05.2015 | Übersichten

Gerinnungsdiagnostik und -therapie bei Leberinsuffizienz

verfasst von: Dr. A. Bienholz, A. Canbay, F.H. Saner

Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin | Ausgabe 3/2016

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Zusammenfassung

Hintergrund

Das Vorliegen einer fortgeschrittenen Leberfunktionseinschränkung geht mit komplexen Veränderungen der Gerinnung einher. Während in der einen Patientengruppe lebensbedrohliche Blutungskomplikationen die Prognose maßgeblich mitbestimmen, stehen insbesondere bei Patienten mit cholestatisch bedingter Lebererkrankung häufig thrombembolische Komplikationen im Vordergrund. Die Parameter der konventionellen laborchemischen Gerinnungsdiagnostik, wie Quick-Wert, aktivierte partielle Thromboplastinzeit (aPTT) und Thrombozytenzahl, können das veränderte Gleichgewicht pro- und antikoagulatorischer Faktoren nicht vollständig erfassen und sind zur Abschätzung des Blutungs- bzw. Thromboserisikos bei Patienten mit akutem Leberversagen oder dekompensierter Leberzirrhose häufig nicht ausreichend.

Diagnostik und Therapie

Durch den Einsatz einer patientennahen Gerinnungsdiagnostik unter Anwendung der Thrombelastometrie/-graphie, einer Thrombozytenfunktionstestung mittels Impedanzaggregometrie sowie gezielter Einzelfaktorenbestimmungen wird insbesondere bei Blutungskomplikationen oder im Rahmen invasiver Eingriffe eine zielgerichtete kausale Therapie der hepatischen Gerinnungsstörung ermöglicht. Dies konnte in den letzten Jahren insbesondere im Rahmen der Lebertransplantation nicht nur zu einer Reduktion der Blutungskomplikationen, sondern auch zu einer deutlichen Einsparung an nebenwirkungsbehafteten Transfusionen allogener Blutprodukte beitragen.

Diskussion

In der vorliegenden Übersichtsarbeit sollen die vielschichtigen pathophysiologischen Veränderungen der Hämostase bei fortgeschrittener Leberinsuffizienz dargestellt werden sowie Diagnosemöglichkeiten und Therapieansätze diskutiert werden.

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Titel: Gerinnungsdiagnostik und -therapie bei Leberinsuffizienz
verfasst von: Dr. A. Bienholz
A. Canbay
F.H. Saner
Publikationsdatum: 05.05.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin / Ausgabe 3/2016
Print ISSN: 2193-6218
Elektronische ISSN: 2193-6226
DOI: https://doi.org/10.1007/s00063-015-0027-x

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Gerinnungsdiagnostik und -therapie bei Leberinsuffizienz

Zusammenfassung

Hintergrund

Diagnostik und Therapie

Diskussion

Neu im Fachgebiet AINS

Magen-Darm-Blutungen werden präklinisch oft falsch eingeschätzt

Sepsis-Verdacht: Eine Stunde, fünf essenzielle Maßnahmen

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

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Hintergrund

Diagnostik und Therapie

Diskussion

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