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Erschienen in: Notfall + Rettungsmedizin 7/2013

01.11.2013 | Leitthema

Kontroversen im Gerinnungsmanagement

verfasst von: Dr. D. Dirkmann, M. Burggraf, P. Brendt, B. Hußmann, J. Peters, S. Lendemans

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 7/2013

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Zusammenfassung

Hintergrund

Die Versorgung polytraumatisierter Patienten ist zeitkritisch und stellt das interdisziplinäre Behandlungsteam vor große Herausforderungen. Zumindest 40 % traumaassoziierter Todesfälle werden unkontrollierten Blutungen zugeschrieben, und der hämorrhagische Schock nach Trauma ist die häufigste Ursache für vermeidbare Todesfälle.

Methode

Recherche und Auswertung der Literatur.

Ergebnisse und Schlussfolgerungen

Neben früher chirurgischer Blutstillung und Optimierung der nicht selten vernachlässigten Rahmenbedingungen hat eine frühe Gerinnungs- und Transfusionstherapie ein großes Potenzial, die Letalität des Schwerstverletzten zu reduzieren. Eine schnelle, gezielte Substitution mit Blut- und Gerinnungsprodukten in der Initialphase nach Trauma vermag die unmittelbare Letalität, aber auch mögliche Dauerschäden durch traumaassoziierte Koagulopathie (TIK) suffizient zu konterkarieren. Während der Stellenwert einer frühzeitigen Injektion der antifibrinolytisch wirksamen Tranexamsäure als gesichert gelten darf, werden ein möglicher Nutzen Point-of-Care-durchführbarer, viskoelastischer Gerinnungsassays und die Transfusion von Gerinnungsfaktorkonzentraten weiterhin kontrovers diskutiert.
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Metadaten
Titel
Kontroversen im Gerinnungsmanagement
verfasst von
Dr. D. Dirkmann
M. Burggraf
P. Brendt
B. Hußmann
J. Peters
S. Lendemans
Publikationsdatum
01.11.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 7/2013
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-013-1713-y