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Hämostasestörungen – Diagnostik und Therapie

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Sepsis und MODS

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Zusammenfassung

Typisch für eine disseminierte intravasale Gerinnung (DIC) bei Sepsis ist die Kombination aus massiver Thrombingenerierung und Thrombozytenaktivierung bei gleichzeitig stark beeinträchtigter Fibrinolyse

Die Gabe von Antithrombin (AT) bei Sepsis mit disseminierter intravasaler Gerinnung (DIC) stellt ein sinnvolles Behandlungskonzept dar, was sich auch in der Leitlinienempfehlung der Bundesärztekammer widerspiegelt (Supplementierung zur Erzielung von Normalwerten). Die Evidenzsicherung für dieses Therapiekonzept im Rahmen einer prospektiv randomisierten Studie steht aus.

Auch für die Heparingabe bei Sepsis mit DIC gibt es derzeit keine Evidenz. Aus forensischen Gründen kann aber auf eine adäquate Thromboseprophylaxe (physikalisch oder medikamentös) auch beim septischen Patienten nicht verzichtet werden. Bei einem Großteil der Patienten mit DIC liegt eine hämorrhagische Diathese vor (Kontraindikation für Heparin).

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Authors and Affiliations

  1. Gerinnungspraxis Mannheim, Belchenstraße 1-5, 68163, Mannheim-Lindenhof, Deutschland

    Prof. Dr. med. C.-E. Dempfle

  2. Sektion Gefäßchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    Prof. Dr. med. J.N. Hoffmann

Authors
  1. Prof. Dr. med. C.-E. Dempfle
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  2. Prof. Dr. med. J.N. Hoffmann
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Correspondence to C.-E. Dempfle .

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Editors and Affiliations

  1. Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle(Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle(Saale), Germany

    Karl Werdan

  2. Lehrstuhl für Geriatrie, Charité-Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Berlin, Germany

    Ursula Müller-Werdan

  3. Hildesheim, Germany

    Hans-Peter Schuster

  4. Zentrum für Klinische Studien, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Germany

    Frank M. Brunkhorst

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Dempfle, CE., Hoffmann, J. (2016). Hämostasestörungen – Diagnostik und Therapie. In: Werdan, K., Müller-Werdan, U., Schuster, HP., Brunkhorst, F. (eds) Sepsis und MODS. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45148-9_14

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