Präinterventionelles Hämostasemanagement – Risikoevaluation und therapeutische Konsequenzen

 

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Hämostasestörungen können das periinterventionelle Blutungs- und Thromboserisiko erhöhen. Zur Eingriffsvorbereitung gehört deswegen eine Risikoevaluation, um potentielle Risikopatienten zu erkennen und gezielte therapeutische Maßnahmen einzuleiten. Das entscheidende Element der Risikoevaluation ist die Blutungs- und Thromboseanamnese. Eine unauffällige Anamnese macht das Vorliegen einer Hämostasestörung unwahrscheinlich. In diesen Fällen wird keine zusätzliche Gerinnungsanalytik empfohlen. Ergibt die Anamnese einen Hinweis auf ein erhöhtes Blutungs- oder Thromboserisiko, wird eine differenzierte laboranalytische Abklärung empfohlen. In Abhängigkeit vom Ergebnis kann durch spezifische Therapiemaßnahmen oder allgemeine hämostyptische Maßnahmen das Blutungsrisiko gesenkt werden. Im Fall eines erhöhten Thromboserisikos kann eine forcierte antithrombotische Therapie die übliche Thromboseprophylaxe ergänzen. Ein besonderes Risikokollektiv bilden Patienten, die mit Antikoagulanzien oder Thrombozytenfunktionshemmern behandelt werden. Diese iatrogenen Risikopatienten erfordern ein Hämostasemanagement, das es ermöglicht, das eingriffsassoziierte Blutungsrisiko zu senken, ohne das Thromboserisiko überproportional zu steigern.

Coagulation disorders may predispose patients to an increased risk of hemorrhage or thrombosis during diagnostic or therapeutic interventions. Pre-interventional haemostatic assessment is therefore recommended in order to identify potential high-risk patients and to introduce targeted therapeutic interventions. A detailed patient interview to determine any personal or familiy history of haemorrhagic diathesis plays a central role in determining the perioperative bleeding risk. Patients with no history of haemorrhagic complications are at low risk for peri-interventional hemorrhage and should not undergo routine pre-interventional hemostasis testing. Patients showing a positive history should undergo a detailed haemostasis testing and should receive appropriate medical and surgical treatment. Patients with an increased risk of thrombosis should receive an intensified antithrombotic prophylaxis. Patients treated with antithrombotic agents are at high risk of peri-interventional haemorrhage and require a haemostatic management that lowers the risk of bleeding without increasing the risk of thrombosis significiantly.

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