Fries Dietmar
Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Wien Med Wochenschr. 2011 Feb;161(3-4):68-72. doi: 10.1007/s10354-011-0878-6.
Incidence of deep vein thrombosis in critically ill patients depends on the underlying disease but may be as high as 60%. The Surviving Sepsis Campaign clearly recommends administering anticoagulation in the absence of specific contraindications in patients with severe sepsis or septic shock. The article discusses risk factor for thromboembolic events in critical illness as well as means of non-pharmacologic and pharmacologic thrombosis prophylaxis. Peripheral vasoconstriction, edema, shock, and administration of catecholamines may reduce the bioavailability and efficacy of subcutaneous administration of low molecular weight heparin. This article further elaborates on the problem and pathophysiology of heparin resistance. Continuous intravenous administration of new anticoagulants may be a promising alternative to indirect anticoagulants. Severity of illness and SAPS II-score determine dosing of the direct thrombin inhibitor argatroban which needs to be about 10-times lower than in patients without critical illness.
重症患者深静脉血栓形成的发生率取决于基础疾病，但可能高达60%。拯救脓毒症运动明确建议，在没有特定禁忌证的情况下，对严重脓毒症或脓毒性休克患者进行抗凝治疗。本文讨论了危重症患者血栓栓塞事件的危险因素以及非药物和药物预防血栓形成的方法。外周血管收缩、水肿、休克以及儿茶酚胺的使用可能会降低皮下注射低分子量肝素的生物利用度和疗效。本文进一步阐述了肝素抵抗的问题及病理生理学。持续静脉输注新型抗凝剂可能是间接抗凝剂的一种有前景的替代方法。疾病严重程度和简化急性生理学评分II（SAPS II）决定了直接凝血酶抑制剂阿加曲班的给药剂量，该剂量需要比非危重症患者低约10倍。
