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Präoperative Blutungsanamnese

Empfehlungen der Arbeitsgruppe perioperative Gerinnung der Österreichischen Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin

Preoperative evaluation of the bleeding history

Recommendations of the working group on perioperative coagulation of the Austrian Society for Anaesthesia, Resuscitation and Intensive Care

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Zusammenfassung

Der Großteil unerwarteter Blutungen in der perioperativen Phase ist auf Störungen der primären Hämostase – angeboren oder als Folge von Medikamenteneinnahme – zurückzuführen. Dennoch werden in der klinischen Routine die Standardtests der Gerinnung [aktivierte partielle Thromboplastinzeit (aPTT) und Thromboplastinzeit („prothrombin time“, PT)] erhoben, mit denen das Blutungsrisiko nicht beurteilt werden kann. Die Arbeitsgruppe für perioperative Gerinnung (AGPG) der Österreichischen Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin (ÖGARI) empfiehlt daher die Verwendung eines standardisierten Fragebogens zum Blutungsrisiko als Teil der anästhesiologischen Patientenaufklärung. Gesunde Patienten der American-Society-of-Anesthesiologists- (ASA-)Klassen I und II mit einem unauffälligen Ergebnis dieser Untersuchung und ohne vorhersehbares Transfusionserfordernis benötigen keine Standardtests der Blutgerinnung. Bei allen anderen Patienten – also Patienten, die gerinnungsrelevante Medikamente einnehmen, oder solchen, die nicht imstande sind, verwertbare Angaben zu machen, empfiehlt die AGPG folgende Parameter zu bestimmen: Thrombozytenzahl, Thrombozytenfunktionstest, aPTT, PT, Fibrinogenspiegel.

Abstract

Unexpected bleeding in the perioperative period is largely caused by impaired inherited or drug-induced primary haemostasis. Standard tests for plasma coagulation are predominantly employed to gauge the risk of bleeding. In accordance with several reports the subcommittee for perioperative coagulation (AGPG) of the Austrian Society of Anaesthesia, Resuscitation and Intensive Care (ÖGARI) recommends the use of a standardised questionnaire to detect an increased risk of bleeding. Accordingly, healthy patients of the American Society of Anesthesiologists (ASA) grades I and II without any suspicion of impaired haemostasis who are scheduled for procedures without expected transfusion requirements, need no standard tests for coagulation. In all other patients (including patients taking medication affecting coagulation, or patients who are unable to provide adequate information) platelet count, platelet function, aPTT, PT, and fibrinogen levels should be assessed.

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Correspondence to S.A. Kozek-Langenecker.

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Pfanner, G., Koscielny, J., Pernerstorfer, T. et al. Präoperative Blutungsanamnese. Anaesthesist 56, 604–611 (2007). https://doi.org/10.1007/s00101-007-1182-0

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  • DOI: https://doi.org/10.1007/s00101-007-1182-0

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