Möhnle Patrick, Bruegel Mathias, Spannagl Michael
Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Klinik für Anästhesiologie, LMU Klinikum München, Ziemssenstr. 1, 80336, München, Deutschland.
Institut für Laboratoriumsmedizin, LMU Klinikum München, München, Deutschland.
Med Klin Intensivmed Notfmed. 2021 Sep;116(6):499-507. doi: 10.1007/s00063-021-00849-6. Epub 2021 Aug 25.
Critically ill patients are at high risk of hemostasis disorders, which can be associated with both an increased risk of bleeding and an increased risk of thromboembolic events. In the case of acute vascular events, specific therapy with drug anticoagulation or platelet aggregation inhibition is essential. In patients with pre-existing conditions, the appropriate continuation of anticoagulation during intensive care treatment is important. Furthermore, in everyday clinical practice, prophylaxis of thromboembolism as well as the question of potential therapeutic options in the treatment of sepsis and infection-triggered disorders of blood coagulation are important. Specific questions arise with the use of extracorporeal devices such as renal replacement and circulatory assist systems. A number of new anticoagulation and anti-platelet drugs have become available in recent years. Laboratory monitoring of anticoagulation is central. In this overview, current aspects of these topics are presented.
重症患者发生止血障碍的风险很高,这可能与出血风险增加和血栓栓塞事件风险增加有关。在急性血管事件的情况下,使用药物抗凝或抑制血小板聚集的特异性治疗至关重要。对于已有疾病的患者,在重症监护治疗期间适当继续抗凝治疗很重要。此外,在日常临床实践中,预防血栓栓塞以及脓毒症和感染引发的凝血障碍的潜在治疗选择问题也很重要。使用诸如肾脏替代和循环辅助系统等体外设备会出现一些特定问题。近年来有多种新型抗凝和抗血小板药物可供使用。抗凝的实验室监测至关重要。在本综述中,将介绍这些主题的当前情况。