Direkte Thrombininhibitoren

Abstract

The options for drug-controlled anticoagulation are becoming noticeably more manifold. In the area of anaesthesiology and intensive care, there are furthermore special disease patterns, such as heparin-induced thrombocytopenia (HIT) to be known, diagnosed and treated. This article gives a review of the substance groups of the direct thrombin inhibitors (DTI) as alternative anticoagulants for HIT in combination with cardiovascular diseases. For the administration of DTIs, experience and the correct dose are the keys to success and are the deciding factors for the two sides of haemostasis: thrombosis and haemorrhage.

Safety of Plasma Volume Expanders

“…62,63 In a pooled analysis of randomized clinical trials of HES 130/0.42 use in major surgery, modestly improved results, equivalent to transfusion of less than 1 whole red cell unit, were obtained relative to HES 200/0.5. 64 A polemic around this study 65 points out that some trials showing equivalence between the 2 forms of HES were excluded from the pooled analysis 66 ; the authors' rebuttal that the excluded study compared nonequivalent HES on the basis of plant source is problematic given the finding that this is not the case for HES 130/0.42. 67 In patients with severe head injury who received HES 130/0.4 and HES 200/0.5 in high cumulative doses, cerebrovascular bleeding events were similar in both groups.…”

Heparininduzierte Thrombozytopenie Typ II mit Thrombosen bei einem Intensivpatienten

“…Weiterhin ermöglichen die kurze Eliminationshalbwertszeit (52±16 min) und die reversible Bindung an Thrombin ein rasches Reagieren auf klinische Notwendigkeiten. So waren unter den empfohlenen Karenzzeiten für Argatroban sowohl ein Eingriff an der Trachea als auch eine rückenmark-nahe Anästhesie ohne erhöhte Blutungsneigung möglich [7]. Bei klinischer Verschlechterung, wie einer Sepsis mit Multiorganversagen oder bei Leberinsuffizienz, verringert sich der Dosisbedarf des hepatisch-eliminierten Wirkstoffs Argatroban akut.…”