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Critical Care 04/2012; 4:1-2. · 4.93 Impact Factor
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ABSTRACT: In respect to the actual discussion of new anticoagulants in secondary haemostasis, we will give a short review on established oral anticoagulation with vitamin K antagonists and parenteral anticoagulation by use of heparin. The different coumarin derivatives phenprocoumon, warfarin, and acenocoumarol are compared concerning to the management and influence of pharmacogenetic and pharmacokinetic factors. Studies to improve the safety of oral anticoagulation by vitamin K supplementation will be briefly discussed. The therapy with heparins include until now some problems of dose-response control. It is necessary to pay attention to contra-indications even for well known anticoagulants. Examples for that will be given.
Hamostaseologie 09/2009; 29(3):241-6. · 1.19 Impact Factor
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ABSTRACT: Oral anticoagulation with a vitamin K-antagonist requires special consideration when surgery or interventional procedures are planned. This is mainly due to the half life of vitamin K-antagonists and to the need for safe and effective anticoagulation prior to and during surgery as well as in the postoperative period. So far, the continuous infusion of unfractionated heparin (UFH) has been the medication of choice to "bridge" patients to surgery. The use of low molecular weight heparins (LMWH) has been prospectively investigated in this setting and represents a safe alternative. The advantages of LMWH are the better dose-response relationship and reduced need for monitoring. This facilitates the bridging procedure to be started out of hospital, which may reduce hospital stay and associated costs. Furthermore, the so-called bridging of patients with oral anticoagulation prior to and during surgery reduces bleeding complications and maintains a safe anticoagulation for patients at risk.
Hamostaseologie 02/2009; 29(3):247-55. · 1.19 Impact Factor
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ABSTRACT: The findings of a large prospective study designed to identify primary and/or secondary haemostatic disorders before surgical interventions are presented. A total of 5649 unselected adult patients were enrolled to identify impaired haemostasis before surgical interventions. Each patient was asked to answer a standardized questionnaire concerning bleeding history. Activated partial thromboplastin time (aPTT), prothrombin time (PT), and platelet counts (PC) including PFA-100 (platelet function analyzer): collagen-epinephrine (C/E), and collagen-ADP (C/ADP) were routinely done in all patients. Additional tests, bleeding time (BT), von Willebrand factor (VWF:Ag, VWF:Rcof) and a further haemostaseological diagnostic was performed only in patients with a positive bleeding history and/or evidence of impaired haemostasis; e.g., drug ingestion. The bleeding history was negative in 5021 patients (88.8%) but positive in the remaining 628 (11.2%). Impaired haemostasis could be verified only in 256 (40.8%) of these patients. The vast majority was identified with PFA-100: C/E (n = 250; 97.7%). The sensitivity of the PFA-100: collagen-epinephrine was the highest (90.8%) in comparison to the other screening tests (BT, aPTT, PT, VWF : Ag). The positive predictive value (to detection of impaired haemostasis) of the PFA-100: collagen-epinephrine with the standardized questionnaire was high (82%), but the negative predictive value was higher (93%). The use of a standardized questionnaire and, if indicated, the PFA-100: C/E and/or other specific tests not only ensure the detection of impaired haemostasis in almost every case but also a significant reduction of the costs. Based on these data, national regards are formulated or under construction.
Hamostaseologie 09/2007; 27(3):177-84. · 1.19 Impact Factor
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ABSTRACT: Total of 5649 unselected adult patients were enrolled to identify impaired hemostasis prior to surgical interventions. Each
patient was asked to answer a standardized questionnaire of bleeding history. Activated partial thromboplastin time (aPTT),
prothrombin time (PT) and platelet counts (PC) including PFA-100 (platelet function analyzer): collagen-epinephrine (C/E)
and collagen-ADP (C/ADP) were routinely done in all patients. Additional tests, bleeding time (BT) and von Willebrand factor
(vWF: Ag) were performed only in patients with a positive bleeding history and/or evidence of impaired hemostasis, e.g. drug
ingestion.
The bleeding history was negative in 5021 patients (88.8%) but positive in the remaining 628 (11.2%). Impaired hemostasis
could be verified only in 256 (40.8%) of these patients. The vast majority were identified by PFA-100: C/E (n = 250; 97.7%).
The only abnormality found among patients with a negative bleeding history was a prolonged aPTT due to lupus anticoagulant
in 9 patients (0.2%). The sensitivity of the PFA-100: collagen-epinephrine was the highest (90.8%) in comparison to the other
screening tests (BT, aPTT, PT, vWF: Ag). The positive predictive value of the PFA-100: collagen-epinephrine was high (81.8%),
but the negative predictive value was higher (93.4%).We identified 254 out of 5649 unselected patients scheduled for surgery
at our hospital as having either acquired (n = 182) or inherited (n = 72) impaired primary hemostasis (platelet dysfunction
including von Willebrand disease). All patients were initially pretreated with desmopressin (DDAVP) and further anti-bleeding
drugs in case of DDAVP-non-response. Response to DDAVP or subsequent treatment(s) was defined as correction of any one of
the abnormal PFA-100 platelet function tests. The non-responders were additionally treated with tranexamic acid or aprotinin;
those with von Willebrand disease (vWD) received factor VIII concentrates with von Willebrand factor (vWF). Those still unresponsive
to therapy received conjugated estrogens and, as a last attempt, a platelet transfusion.
The administration of DDAVP led to a correction of platelet dysfunction in 229 of the 254 patients treated (90.2%). Tranexamic
acid was effective in 12 of 16, aprotinin in 3 of 5 and factor VIII concentrates with vWF in all 4 patients with unresponsive
to DDAVP. The remaining 6 patients were pretreated with conjugated estrogens, and 2 of these patients were additionally treated
with platelet transfusion. The frequency of blood transfusion was lower, but not statistically significant (9.4% vs. 12.2%:
p = 0.202) in preoperatively treated patients with impaired hemostasis than in patients without impaired hemostasis. In a
retrospective group, the frequency of blood transfusion was statistically significant higher (89.3% vs. 11.3%: p < 0.001)
in patients without preoperative correction of impaired than in patients without impaired hemostasis.
Preoperative identification and correction of impaired primary hemostasis is possible in nearly all patients affected, and
results in a reduction of homologous blood transfusions.
12/2006: pages 78-89;
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ABSTRACT: A reduced peritoneal fibrinolytic capacity after surgery is currently accepted to be the main cause for postoperative adhesions. The aim of this prospective randomized trial was to determine the fibrinolytic activity in peritoneal fluid after laparoscopic as compared to conventional colorectal resection.
A randomized controlled trial in parallel with the multicenter trial Lapkon II was conducted. Peritoneal fluid was sampled via drain at 2, 8, and 24 h after elective laparoscopic (n=14; LAP) and conventional (n=16; CON) colorectal resections. Activities and concentrations of tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1) and t-PA/PAI complex were determined in all specimen by ELISA kits.
There was no difference in age, sex or body mass index between both groups. Postoperatively, t-PA activity decreased in both groups and was lower 2 h after closing the abdomen in the laparoscopic group (p<0.05). PAI-1 activity and concentration increased in both groups. Difference between the groups was measured for PAI-1 concentration after 24 h (p<0.05). There were no differences between the groups regarding t-PA concentrations, PAI-1 activity and t-PA/PAI complex.
After closing the abdominal cavity, postoperative changes in fibrinolytic capacity of peritoneal fluid can be determined in samples collected by a drain. However, there were no major differences in the postoperative course of fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resections.
Langenbeck s Archives of Surgery 12/2005; 390(6):523-7. · 1.81 Impact Factor
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ABSTRACT: We describe a 60-year-old female patient without vascular risk factors diagnosed with cardioembolic ischemic stroke due to an atrial septal aneurysm with a right-to-left shunt. However, further investigation after recurrent strokes revealed a nonbacterial thrombotic endocarditis (NBTE) caused by a metastatic adenocarcinoma. The presented case illustrates the difficulties in establishing the diagnosis of NBTE premortally and points out the importance of repeated echocardiographic evaluations of cardiac valves and serological examination of tumor markers in patients with recurrent strokes of unknown origin.
Der Nervenarzt 05/2005; 76(4):471-4. · 0.68 Impact Factor
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ABSTRACT: Clopidogrel, an irreversible ADP-receptor antagonist, inhibits platelet aggregation mediated by reduced activation of glycoprotein receptor IIb/IIIa. Clopidogrel in combination with aspirin has been shown to be superior to aspirin alone for treating unstable angina, but clopidogrel recipients have shown increases in blood loss, transfusion requirements, and rate of reoperation after cardiac surgery. We describe a patient who had taken clopidogrel 75 mg daily until the day prior to coronary artery bypass graft surgery. Severe postoperative bleeding developed and was refractory to conventional hemostatic therapy consisting of 19 units of packed red blood cell concentrates, 16 of fresh frozen plasma, 8 of platelet apheresis concentrates plus high-dose treatment with aprotinin (500.000 kallikrein-inhibiting units/h) and administration of 0.3 microg/kg 1-deamino-8-D-arginine vasopressin (DDAVP). Two reoperations were performed, but surgical hemostasis was not achieved, so 100 microg/kg recombinant activated factor VII was applied to generate sufficient thrombin to stop the bleeding. This treatment approach reduced the bleeding. Then, to promote clot formation and firmness, 2 g of fibrinogen and 1250 IU of factor XIII were administered, and the bleeding finally stopped. No further transfusions were required, and the patient was discharged from the hospital on day 10 after the operation. This case suggests that in clopidogrel-related bleeding refractory to conventional hemostatic therapy, hemostasis may be achieved by a stepwise administration of coagulation factor concentrates.
Heart Surgery Forum 02/2005; 8(1):E39-41. · 0.63 Impact Factor
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ABSTRACT: Wir berichten ber eine 60-jhrige Patientin ohne vaskulre Risikofaktoren, bei der nach einem Territorialinfarkt ein Vorhofseptumaneurysma mit einem Rechts-links-Shunt als Emboliequelle postuliert wurde. Die Verlaufsuntersuchungen nach erneuten Schlaganfllen ergaben jedoch den Befund einer nichtbakteriellen thrombotischen Endokarditis (NBTE) bei einem metastasierten Adenokarzinom. Unsere Kasuistik illustriert die Schwierigkeiten bei der prmortalen Diagnosestellung der NBTE und weist auf die Bedeutung der wiederholten echokardiographischen Herzklappendarstellung sowie der Bestimmung von Tumormarkern bei tiologisch ungeklrten rezidivierenden Schlaganfllen hin.We describe a 60-year-old female patient without vascular risk factors diagnosed with cardioembolic ischemic stroke due to an atrial septal aneurysm with a right-to-left shunt. However, further investigation after recurrent strokes revealed a nonbacterial thrombotic endocarditis (NBTE) caused by a metastatic adenocarcinoma. The presented case illustrates the difficulties in establishing the diagnosis of NBTE premortally and points out the importance of repeated echocardiographic evaluations of cardiac valves and serological examination of tumor markers in patients with recurrent strokes of unknown origin.
Der Nervenarzt 01/2005; 76(4):471-474. · 0.68 Impact Factor
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ABSTRACT: Although the pneumoperitoneum decreases venous reflux from the lower extremities, the rate of thromboembolic complcations seems to be lower after laparoscopic than after conventional procedures. Therefore, it has been assumed that laparoscopic surgery better preserves the intravasal fibrinolytic capacity. The aim of this study was to determine the influence of the operative technique on intravasal fibrinolytic capacity in colorectal resection.
Randomized controlled trial conducted in parallel with the multicenter trial LAPKON II comparing the long-term effects of elective laparoscopic (group I) and conventional (group II) resections for colorectal cancer. Blood samples were taken from 30 patients preoperatively, at the beginning and end of surgery as well as 2, 8, and 24 hr postoperatively. Activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), tPA/PAI complex, fibrinogen, and D-dimers were determined in all specimen with ELISA tests. Area under the curve values (AUC) were calculated for all parameters.
Patient characteristics and indication for surgery were not different between both groups. Preoperative values of fibrinolytic parameters were similar in both groups. Postoperatively, tPA activity decreased significantly in both groups, but AUC values for tPA and PAI-1 activity (p = 0.23; p = 0.68); concentration of tPA, PAI-1, and tPA/PAI complex (p = 0.52; p = 0.78; p = 0.95); and concentration of fibrinogen and D-dimers (p = 0.67; p = 0.71) did not differ between the groups.
An intravasal fibrinolytic "shutdown" occurs not only after conventional but also after laparoscopic colorectal resection. Both operative techniques had similar effects on postoperative intravasal fibrinolytic capacity. Therefore, the lower incidence of thromboembolic complications after laparoscopic colorectal resections does not seem to be caused by a lesser depression of the intravasal fibrinolytic capacity.
Surgical Endoscopy 02/2003; 17(1):73-7. · 4.01 Impact Factor
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ABSTRACT: Reduced fibrinolytic activity of the peritoneum seems to be the main cause of postoperative adhesions. This prospective randomized trial compared the peritoneal fibrinolytic activity between laparoscopic and conventional colorectal resection.
Parietal peritoneal biopsy specimens were taken in standardized elective laparoscopic ( n=14) and conventional ( n=16) colorectal resections at the beginning and at the end of surgery. Activities and concentrations of tissue-plasminogen activator (tPA), plasminogen activator (PAI) type 1, and tPA/PAI complex were determined by ELISA kits.
There was no difference in age, sex, or body mass index between the two groups. Perioperative tPA activity decreased in both groups without differences between the groups. Concentrations and activities of tPA, PAI-1, and tPA/PAI complex did not differ between the groups at any time.
Peritoneal concentrations and activities of tPA, PAI-1, and tPA/PAI complex are similar during laparoscopic and conventional colorectal resections. A capnoperitoneum of 12 mmHg over 3 h did not affect the peritoneal fibrinolytic activity
International Journal of Colorectal Disease 12/2002; 17(6):426-9. · 2.38 Impact Factor
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ABSTRACT: To establish the influence of the peritoneal sampling technique on the measurement of fibrinolytic capacity.
Clinical study.
University hospital, Germany.
40 peritoneal biopsy specimens were taken from 10 patients who were having elective colorectal resections.
Peritoneal biopsy specimens were taken either with a biopsy punch (n = 20) or manually with forceps and scissors (n = 20).
Extent of agreement in fibrinolytic activities between specimens taken with biopsy punch and manually. Major endpoint-peritoneal tissue plasminogen activator (t-PA) activity. Minor endpoints-peritoneal tissue plasminogen activator concentration, and concentration and activity of plasminogen activator inhibitior type 1 (PAT-1).
Intra-assay agreement and the extent of agreement between the groups were evaluated by the method of Bland and Altman. Correlation of repeated measurements of t-PA and PAI-1 concentrations and activities from the same sample using the same ELISA kit was high (r = 0.93-0.99, p < 0.01). t-PA activities and concentrations between the groups correlated poorly (r= 0.60 and 0.66, p < 0.01) while no correlation at all was seen for PAI-1 concentration and activity between the groups (r = 0.6 and 0.1, p = 0.2 and 0.9). The mean differences between the groups ranged from -27% to -4.8%.
The sampling technique considerably affects the measurement of peritoneal fibrinolytic activity.
The European Journal of Surgery 02/2002; 168(11):635-40.
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ABSTRACT: The recurrence of widespread and diverse vascular lesions is a hallmark of systemic lupus erythematosus (SLE). Inflammatory and thrombotic mechanisms almost invariably associated with circulating antiphospholipid antibodies play a role in the pathogenesis of SLE-related vascular disease. Both mechanisms can coexist in the same patient. Vasculitis is most commonly induced by the local deposition of immune complexes. However, some SLE patients have an inflammatory complement-mediated vascular injury in the absence of immune complex deposition. We report on a fatal case of disseminated intravascular coagulation (DIC) in a young woman with active SLE. Hemorrhagic lesions due to localized intravascular coagulation (Shwartzman phenomenon) preceded disseminated intravascular coagulation accompanied by disseminated cardiac necrosis. Immune complex 'independent' and other mechanisms of vascular injury and states of hypercoagulability will be discussed.
Lupus 02/2002; 11(4):204-7. · 2.34 Impact Factor
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ains · Anästhesiologie · Intensivmedizin 11/2001; 36(10):628-39. · 0.41 Impact Factor
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ABSTRACT: To compare the efficacy and safety of hirudin and heparin for anticoagulation during continuous renal replacement therapy (CRRT) in critically ill patients.
Prospective, randomized controlled pilot study.
Single centre; interdisciplinary intensive care unit at a university hospital.
Seventeen patients receiving CRRT.
Patients were randomly allocated to two groups. Heparin group (nine patients): continuous administration of 250 IU/h heparin; dose was adjusted in 125 IU/h steps with a targeted activated clotting time (ACT) of 180-210 s. Hirudin group (eight patients): continuous infusion of 10 micrograms/kg/h hirudin, dose was adjusted in 2 micrograms/kg/h steps with a targeted ecarin clotting time (ECT) of 80-100 s. Observation time was 96 h.
Measured filter run patency and haemofiltration efficacy did not significantly differ between the two groups. Three bleeding complications were observed in the hirudin group, none in the heparin group (P < 0.01). At the onset of bleeding, which occurred 60 or more hours after the start of therapy, only one patient was still under continuous hirudin administration but levels were either in therapeutic range or below.
Hirudin can be used efficiently for anticoagulation in CRRT. Late bleeding complications may have been caused by possible hirudin accumulation, but this was not evident from hirudin plasma and ECT levels. Since bleeding complications were observed only in the presence of documented coagulation disorders, not only adequate drug monitoring but also the plasmatic and cellular coagulation status of the patient should be taken into consideration for adjusting hirudin dosage.
Intensive Care Medicine 04/2001; 27(4):673-9. · 5.40 Impact Factor
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ABSTRACT: There is some evidence that the Trp64Arg polymorphism of the beta3-adrenergic receptor (beta3-AR) is associated with atherogenic risk factors that include weight gain, insulin resistance, and diabetes. The objective of this cross-sectional study was to investigate the relationship between the Trp64Arg polymorphism and coronary artery disease (CAD). A total of 1,000 consecutive patients with angiographically confirmed CAD and 1,000 controls, carefully matched for age and sex, were genotyped for the Trp64Arg polymorphism by polymerase chain restriction and subsequent restriction fragment length polymorphism analysis. Among cases with CAD, 83.3% were wild-type Trp/Trp, 15.8% were heterozygotes, and 0.9% were homozygous Arg/Arg compared with 82.3%, 17.3%, and 0.4%, respectively, among controls (P = .27). The odds ratios for the presence of Trp/Arg and Arg/Arg in cases and controls were 0.90 (95% confidence interval [CI] 0.7 to 1.2; P = .40) and 2.2 (95% CI 0.7 to 7.2; P = .17), respectively. There was no effect modification by gender and atherogenic risk factors, including diabetes, hypercholesterolemia, hypertension, and smoking. Furthermore, there was no evidence of an association with premature disease onset (< 40 years) or extent of disease. In conclusion, the results of this study in a large sample of clinically well-characterized patients indicate that neither the Trp/Arg nor the Arg/Arg genotype represents a major risk factor for angiographically confirmed coronary artery disease.
Metabolism 03/2001; 50(2):184-8. · 2.66 Impact Factor
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ABSTRACT: Hereditary thrombophilias are a heterogenous group of genetic coagulation disorders which, particularly in combination with acquired prothrombotic factors, induce a predisposition to thrombosis. After characterization of frequent thrombophilic syndromes like factor V-Leiden or the prothrombin 20210GA mutation, a number of case-control studies screened for the prevalence of these mutations in ischemic stroke and cerebral venous thrombosis (CVT). Our meta-analysis shows that factor V-Leiden and prothrombin are frequent and significantly associated with CVT (16.4% vs. 4.9% or 4.3, P < 0.001, and 12.1% vs. 1.9% or 5.8, P < 0.001). In ischemic stroke, only factor V-Leiden and not prothrombin is a weak but significant risk factor (5.9% vs. 2.6% or 1.6, P < 0.001, and 4.1% vs. 3.3% or 1.4, P = 0.1). The C677T homozygous point mutation in the MTHFR, a homocysteine-degrading enzyme, was also associated with arterial stroke (16% vs. 15% or 1.5, P < 0.001). For CVT, sufficient data are lacking. We therefore recommend screening for thrombophilia in CVT. In ischemic stroke, atrial premature complex (APC) resistance should be considered. As long as controlled studies are lacking, individual anticoagulant therapy must take hereditary and precipitating factors into account to assess potential thrombotic risk.
Der Nervenarzt 01/2001; 71(12):936-45. · 0.68 Impact Factor
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ABSTRACT: Autoimmune phenomena in lymphoid malignancies are often observed. However, clinical manifestations such as a secondary antiphospholipid syndrome in the presence of antiphospholipid antibodies are rarely reported. Furthermore, in the few cases of lymphomas so far reported with thrombosis associated with elevated antiphospholipid antibodies, the anti-beta2-glycoprotein-I antibodies have not been studied. We report on two cases of arterial thrombosis occuring in patients with B-cell lymphoma who presented with positive anticardiolipin and anti-beta2-glycoprotein-I antibodies. Our observation suggests that patients with non-Hodgkin's lymphoma and both anticardiolipin and anti-beta2-glycoprotein-I antibodies may be, similar to lupus patients, at considerable risk towards thrombosis, especially towards arterial thrombosis.
European Journal Of Haematology 12/2000; 65(5):344-7. · 2.61 Impact Factor
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P M Mrozikiewicz,
I Cascorbi, S Ziemer,
M Laule,
C Meisel,
V Stangl,
W Rutsch,
K Wernecke,
G Baumann,
I Roots,
K Stangl
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ABSTRACT: We have focused on the role of coagulation factor VII (FVII) Arg353Gln polymorphism as a risk predictor of complications following percutaneous transluminal coronary angioplasty (PTCA), directional coronary atherectomy (DCA), and stenting.
The FVII Arg353Gln mutation decreases FVII activity, and presence of the Gln353 allele could be protective against thrombus formation during catheter interventions.
A total of 666 consecutive patients with coronary artery disease who had undergone PTCA (n = 280), DCA (n = 104), or stenting (n = 282) were followed up for a 30-day composite end point, which included need for target vessel revascularization, myocardial infarction, and death. The Arg353Gln polymorphism of FVII was determined by PCR/RFLP assay.
Carriers of the Gln353 allele had significantly lower levels of total FVII activity (FVIIc, -20.7%, p < 0.001) and of activated circulating FVII (FVIIa, -32.7%, p = 0.03) compared with Arg353/Arg353. The composite end point occurred in 43 patients: 4 were heterozygous Arg353/Gln353, and 39 were homozygous Arg353/Arg353. The incidence of the composite end point was 2.5% in carriers of the Gln353 allele and 7.7% in Arg353/Arg353 homozygotes (p = 0.013). This corresponds to a 72% risk reduction in carriers of the Gln353 allele (relative risk: 0.28; 95% confidence interval: 0.09-0.81; p = 0.02).
The Gln353 allele of FVII is associated with substantial risk reduction in adverse events that complicate coronary catheter interventions. With the perspective of active site-blocked activated FVII (FVIIai) as conjunctive medication, the results suggest that the FVII genotype should be taken into due consideration in assessment of FVIIai medication and of its dosage.
Journal of the American College of Cardiology 11/2000; 36(5):1520-5. · 14.16 Impact Factor
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ABSTRACT: Hereditäre Thrombophilien sind eine heterogene Gruppe von erblichen Gerinnungsstörungen, die, selten als alleinige Ursache,
in einer komplexen Interaktion mit erworbenen Risikofaktoren zu Thrombosen führen. Nach der Entdeckung von genetisch gut charakterisierten
und häufigen Thrombophilien wie dem Faktor V-Leiden oder der Prothrombinmutation 20210GA wurden diese Mutationen in größeren
Fallkontrollstudien auch bei Schlaganfall und zerebralen Sinus- und Venenthrombosen (SVT) untersucht. In unserer Meta-Analyse
zeigt sich dabei, dass die heterozygote Faktor V-Leiden-Mutation die häufigste Gerinnungsstörung ist und für SVT (16,4% vs
4,9%; OR: 4,3; p<0,001) und weniger auch für arterielle Ischämien (5,9% vs 2,6%; OR: 1,6; p<0,001) ein schwacher, aber signifikanter Risikofaktor ist. Die Protrombinmutation 20210GA ist dagegen vermutlich nur für
Sinusvenenthrombosen (12,1% vs 1,9%; OR: 5,8; p<0,001), nicht jedoch für Schlaganfälle (4,1% vs 3,3%; OR: 1,4; p=0,1) als eigenständiger Risikofaktor zu betrachten. Die homozygote Form der Methyltetrahydrofolatreduktase-Mutation (MTHFR
C677T), einem homozysteinabbauendem Enzym, ist ein weiterer Risikofaktor für Schlaganfälle (16% vs 15%; OR: 1,5; p<0,001). Für die SVT liegen keine ausreichenden Daten vor. Ein Thrombophilie-Screening für APC-Resistenz und die Prothrombinmutation
erscheint bei der SVT sinnvoll, beim arteriellen Schlaganfall sollte eine APC-Resistenz berücksichtigt werden. Weil kontrollierte
Therapiestudien fehlen, muss die Therapie unter Berücksichtigung von genetischen und auslösenden Faktoren in enger Zusammenarbeit
mit Hämostaseologen dem individuellen Thromboserisiko angepasst werden.
Hereditary thrombophilias are a heterogenous group of genetic coagulation disorders which, particularly in combination with
acquired prothrombotic factors, induce a predisposition to thrombosis. After characterization of frequent thrombophilic syndromes
like factor V-Leiden or the prothrombin 20210GA mutation, a number of case-control studies screened for the prevalence of
these mutations in ischemic stroke and cerebral venous thrombosis (CVT). Our meta-analysis shows that factor V-Leiden and
prothrombin are frequent and significantly associated with CVT (16.4% vs. 4.9% or 4.3, P<0.001, and 12.1% vs. 1.9% or 5.8, P<0.001). In ischemic stroke, only factor V-Leiden and not prothrombin is a weak but significant risk factor (5.9% vs. 2.6%
or 1.6, P<0.001, and 4.1% vs. 3.3% or 1.4, P=0.1). The C677T homozygous point mutation in the MTHFR, a homocystein-degrading enzyme, was also associated with arterial
stroke (16% vs. 15% or 1.5, P<0.001). For CVT, sufficient data are lacking. We therefore recommend screening for thrombophilia in CVT. In ischemic stroke,
atrial premature complex (APC) resistance should be considered. As long as controlled studies are lacking, individual anticoagulant
therapy must take hereditary and precipitating factors into account to assess potential thrombotic risk.
Der Nervenarzt 10/2000; 71(12):936-945. · 0.68 Impact Factor
