Antikoagulation in der Dermatologie

Abstract

The coagulation system protects the body from uncontrolled blood loss by means of highly regulated processes. In case of an injury the coagulation system instantly switches from controlled blood flow to acute coagulation and thrombus formation with the goal of stopping the blood loss. Minor changes in this well-maintained equilibrium of coagulation and blood flow tip the balance towards uncontrolled blood loss or even fatal thromboembolic events. Iatrogenic manipulation of this highly regulated system is possible with a variety of therapeutic agents. We review the basics of coagulation physiology and then discuss dermatologically relevant aspects of thrombosis prevention, as well as the use of anticoagulants to treat dermatologic diseases.

Differential diagnosis and therapy of leg ulcers

“…After appearance of a coumarin necrosis treatment with coumarin must therefore not necessarily be discontinued in contrast to heparin-induced necrosis in heparin-induced thrombocytopenia (HIT), which results from an antibody reaction against the heparin/ platelet factor-4 complex. In this case treatment with heparin must be discontinued immediately [18]. Many drugs with immunosuppressive activity, particularly the antimetabolites, can halt or delay wound healing; these include methotrexate, leflunomide and pentamidine.…”

“…Bild einer leukozytoklastischen Vaskulitis mit flächenhafter Purpura, die teilweise zentrale Nekrosen aufweist. Eine Behandlung mit Heparin muss in diesem Fall sofort abgesetzt werden[18]. Darüber hinaus werden bei bestehender Glomerulonephritis Antibiotika verabreicht (i. d. R. Cotrimoxazol).Bei der LV besteht kaum ein entzündliches Infiltrat und hyaline Wanddegeneration und fibrinoide Ergüsse finden sich besonders in den Gefäßen der oberen und mittleren Dermis.…”