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Erschienen in: Notfall +  Rettungsmedizin 2/2015

01.03.2015 | Konzepte - Stellungnahmen - Leitlinien

Traumaassoziierte Gerinnungsstörung

Mechanismen, Risikoeinschätzung und aktuelle Leitlinien

verfasst von: A. Driessen, Prof. Dr. M. Maegele

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 2/2015

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Zusammenfassung

Problematik und Zielsetzung

Die führende Todesursache beim Trauma innerhalb der ersten 6 h ist die nicht kontrollierte Blutung. Einer von 4 Patienten weist bei Schockraumaufnahme eine Störung seiner Gerinnungsfunktion auf. Inflammation, Gewebehypoperfusion und Aktivierung neurohumoraler Faktoren werden als Treiber der Gerinnungsstörung angeschuldigt und führen über Endothelschädigung zu Hyperpermeabilität, Fibrinolyse und Autoheparinisierung. Die iatrogene Koagulopathie (IC) verstärkt durch Hämodilution, Azidose und Hypothermie („circulus vitiosus“) die primär bestehende Gerinnungsstörung.

Ergebnisse und Schlussfolgerungen

Ein Hauptproblem bleibt die frühe Risikostratifizierung. Standardlaborparameter bieten keine ausreichende Spezifität zur Detektion bereits bestehender Gerinnungsstörungen. Scoring-Systeme als Surrogate zur Vorhersage der Transfusionswahrscheinlichkeit wurden auf Grundlage retrospektiver Daten entwickelt und bislang nicht prospektiv validiert. Viskoelastische Testverfahren bilden die Dynamik und Nachhaltigkeit der Gerinnselbildung rasch ab. Die Therapie orientiert sich an den 2013 aktualisierten Leitlinien.
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Metadaten
Titel
Traumaassoziierte Gerinnungsstörung
Mechanismen, Risikoeinschätzung und aktuelle Leitlinien
verfasst von
A. Driessen
Prof. Dr. M. Maegele
Publikationsdatum
01.03.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 2/2015
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-014-1972-2