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24.01.2018 | Tranexamsäure | Übersichten

Prophylaktische Anwendung von Tranexamsäure in der nichtkardialen Chirurgie

Update 2017

verfasst von: Dr. J. Waskowski, J. C. Schefold, F. Stueber

Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin | Ausgabe 7/2019

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Zusammenfassung

Hintergrund

Die Vermeidung perioperativer Blutungen ist ein zentrales Ziel des „patient blood management“. Ein entsprechender Baustein ist die Hemmung der Fibrinolyse mittels Proteaseinhibitoren, z. B. der Tranexamsäure (TXA). TXA hemmt die Plasminogenaktivierung und somit den Abbau von Fibrin.

Ziele der Arbeit

Der vorliegende Beitrag gibt einen Überblick über die vorhandene Literatur und sich hieraus ergebende Einsatzbereiche von TXA in der Prophylaxe perioperativer Blutungen.

Methoden

Literaturrecherche in PubMed/MEDLINE (U.S. National Library of Medicine®, Bethesda, MD, USA).

Ergebnisse

Randomisierte kontrollierte Studien (RCT) sowie Metaanalysen zeigen, dass TXA den perioperativen Blutverlust und Transfusionsbedarf im Bereich der Hüft- und Knieendoprothetik senkt. Dies gilt für die intravenöse und topische Anwendung. Auch für den Einsatz in der Wirbelsäulenchirurgie und der rekonstruktiven Chirurgie (kindliche Kraniosynostosen) existiert gute Evidenz. Einzelne RCT zeigen einen Nutzen von TXA für abdominale Hysterektomien, die offene Prostatachirurgie, die Tumorchirurgie der Leber und blutende Traumapatienten. Zur Prophylaxe von peripartalen Hämorrhagien (PPH) bei vaginaler Geburt oder Kaiserschnitt wird TXA derzeit nicht generell empfohlen – es existieren jedoch Hinweise auf einen potenziellen Nutzen. Bei aktiver PPH wird der Einsatz empfohlen. Zur prophylaktischen perioperativen Gabe wird für Erwachsene eine Bolusgabe von 1 g bzw. 10–15 mg/kg KG i. v. empfohlen, ggf. wiederholt (nach 6 h) oder ergänzt durch eine Infusion über 8 h. Perioperative Lungenembolien oder tiefe Beinvenenthrombosen treten nach derzeitiger Datenlage nicht gehäuft auf.

Schlussfolgerung

Die prophylaktische Anwendung der TXA unter Beachtung der Kontraindikationen senkt für ausgewählte chirurgische Indikationen den perioperativen Blutverlust sowie den Transfusionsbedarf.

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Titel: Prophylaktische Anwendung von Tranexamsäure in der nichtkardialen Chirurgie
Update 2017
verfasst von: Dr. J. Waskowski
J. C. Schefold
F. Stueber
Publikationsdatum: 24.01.2018
Verlag: Springer Medizin
Schlagwörter: Tranexamsäure
Hysterektomie
Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin / Ausgabe 7/2019
Print ISSN: 2193-6218
Elektronische ISSN: 2193-6226
DOI: https://doi.org/10.1007/s00063-018-0402-5

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