Thrombophilie-Diagnostik bei venöser Thromboembolie – wann ist sie sinnvoll?

 

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Zusammenfassung

Angeborene und erworbene Thrombophilien sind Risikofaktoren für eine erste venöse Thromboembolie (VTE). Hingegen ist das relative Risiko für ein VTE-Rezidiv bei hereditärer Thrombophilie allenfalls moderat erhöht. Die klinische Relevanz wird aber deutlich, wenn man das absolute Risiko betrachtet. Bei Patienten nach VTE ist das Risiko für ein Rezidiv 20-50-fach höher als das Risiko für eine VTE bei Personen ohne vorausgegangenes Ereignis. Ein Thrombophilie-Screening kann daher insbesondere sinnvoll sein bei Patienten mit „intermediärem“ Rezidivrisiko, da hier die Detektion einer sog. „starken“ Thrombophilie die Entscheidung für eine prolongierte Antikoagulation herbeiführen kann.

Abstract

Hereditary and acquired thrombophilias are known risk factors for a first venous thromboembolism (VTE). In contrast, the relative risk of VTE recurrence in presence of hereditary thrombophilia seems to be at most moderately elevated. However, thrombophilia still contributes to a greater extent to the absolute risk of VTE recurrence. This is explained by the 20–50-fold increased risk of VTE in a subject after a first VTE when compared to the state without previous VTE. Testing for thrombophilia may therefore be helpful in patients at intermediate risk of recurrence in whom the finding of a “strong” thrombophilia can bring about a decision for long-term anticoagulation.

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