Präoperative Blutungsanamnese

Pfanner, G.; Koscielny, Jürgen; Pernerstorfer, Thomas; Gütl, M; Perger, P.; Fries, Dietmar; Hofmann, Nikolaus; Innerhofer, Petra; Kneifl, W.; Neuner, L.; Schöchl, Herbert; Kozek‐Langenecker, Sibylle A.

doi:10.1007/s00101-007-1182-0

Cited by 123 publications

(27 citation statements)

References 21 publications

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“…From an epidemiological point of view, hemorrhagic complications are caused by disturbances of thrombocyte function, which is not tested by measuring PT. 28 Furthermore, preoperatively new concepts of hemostasis should be reflected.…”

Section: Discussionmentioning

confidence: 99%

On the value of routine prothrombin time screening in elective neurosurgical procedures

Dützmann

Geßler²,

Marquardt³

et al. 2012

FOC

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Object The authors performed a study to evaluate whether preoperative assessment of prothrombin time (PT) is mandatory in patients undergoing routinely planned neurosurgical procedures. Methods The charts of all patients admitted to general wards of the authors' department for routinely planned surgery (excluding trauma and ICU patients) between 2006 and 2010 were retrospectively reviewed. The authors assessed preoperative PT and the clinical courses of all patients, with special consideration for patients receiving coagulation factor substitution. All cases involving hemorrhagic complications were analyzed in detail with regard to pre- and postoperative PT abnormalities. Prothrombin time was expressed as the international normalized ratio, and values greater than 1.28 were regarded as elevated. Results Clinical courses and PT values of 4310 patients were reviewed. Of these, 33 patients (0.7%) suffered hemorrhagic complications requiring repeat surgery. Thirty-one patients (94%) had a normal PT before the initial operation, while 2 patients had slightly elevated PT values of 1.33 and 1.65, which were anticipated based on the patient's history. In the latter 2 cases, surgery was performed without prior correction of PT. Preoperatively, PT was elevated in 78 patients (1.8%). In 73 (93.6%) of the 78 patients, the PT elevation was expected and explained by each patient's medical history. In only 5 (0.1%) of 4310 patients did we find an unexpected PT elevation (mean 1.53, range 1.37–1.74). All 5 patients underwent surgery without complications, while 2 had received coagulation factor substitution preoperatively, as requested by the surgeon, because of an estimated risk of bleeding complications. None of the 5 patients received coagulation factor substitution postoperatively, and later detailed laboratory studies ruled out single coagulation factor deficiencies. There was no statistically significant association between preoperatively elevated PT levels and the occurrence of hemorrhagic complications (p = 0.12). Before the second procedure but not before the initial operation, 4 (12%) of the 33 patients had elevated PT. Conclusions The findings suggest that the value of preoperative PT testing is limited in patients in whom a normal history can be ascertained. Close postoperative PT control is necessary in every neurosurgical patient, and better tests need to be developed to identify patients who are prone to hemorrhagic complications.

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Section: Discussionmentioning

confidence: 99%

On the value of routine prothrombin time screening in elective neurosurgical procedures

Dützmann

Geßler²,

Marquardt³

et al. 2012

FOC

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“…On the other hand, the study of Roschitz et al [57] shows that the PFA-100 is probably only a good screening method when a haemostatic defect in a patient is clinically likely, especially to screen for von Willebrand syndrome, and the test should not be used in general unselective screening without positive bleeding history. Based on the above mentioned studies and consensus of experts, the scientific committee of the Deutsche Gesellschaft für Anästhesie und Intensivmedizin (DGAI) in agreement with the Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf-und Hals-Chirurgie (DGHNOKC) and the Gesellschaft für Thrombose-und Hä-mostaseforschung (GTH), as well as with the subcommittee for perioperative coagulation of the Österreichische Gesellschaft für Anaesthesiologie, Reanimation und Intensivmedizin (ÖGARI) recommend the use of a standardized questionnaire to detect an increased risk of bleeding [58,59]. Accordingly, healthy patients of the ASA grades I and II without any suspicion of impaired haemostasis who are scheduled for procedures without expected transfusion requirements, need no standard tests for coagulation.…”

Section: Standardized Questionnaire For Bleeding Historymentioning

confidence: 99%

Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis

Görlinger

Jámbor²,

Hanke

et al. 2007

Transfus Med Hemother

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About one third of all blood components transfused intraoperatively is used in cardiac surgery, whereas mortality of cardiosurgical patients correlates nearly linear with the number of transfused units of packed red blood cells. Acquired platelet function disorders play a major role in perioperative bleeding in cardiac surgery. Therefore, the use of point-of-care-suitable platelet function analyzers seems to be reasonable in this field. Methods: Platelet function analyzer PFA-100®, rotational thrombelastometry (ROTEM®), and multiple platelet function analyzer (Multiplate®) are in principle applicable for point-of-care testing. Since these three analyzers monitor different aspects of platelet function and have different limitations, the selection of the right test system depends on the right question. Results: Perioperative use of platelet function analyzers is helpful in prediction of blood loss in cardiac surgery. Perioperative usage of blood components and their respective costs can be reduced by an appropriate coagulation management. Conclusion: Algorithms for perioperative coagulation management based on point-of-care testing permit a fast diagnostic and goal-directed therapy of coagulation and functional platelet disorders. The possibility to reduce the mortality of patients and the overall cost for hospital stay is subject of further studies.

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“…Somit bestimmen die Disposition des Patienten (Art der hämorrhagischen Diathese oder der gerinnungshemmenden Medikation, klinische Ausprägung mit Blutungsanamnese, aktueller klinischer Zustand, Medikation) und die operative Exposition (Art und «Größe» der Operation) das perioperative Blutungsrisiko [3,4]. Aus klinischer Sicht besteht ein besonders hohes perioperatives Blutungsrisiko für Patienten mit hämorrhagischer Diathese oder unter einer gerinnungshemmenden Medikation, wenn eine oder mehrere der folgenden Bedingungen anzutreffen sind:…”

Section: Risikobewertungunclassified

“…- standardisierte Blutungsanamnese [4,5,6] mit ≥3 positiv beantworteten Fragen, d.h. zahlreiche Blutungssymptome (Tab. 1);…”

Section: Risikobewertungunclassified

“…Wegen der zusätzlichen Blutungsgefahr ist die Gabe von ASS (Dosierungen ≥600 mg) oder anderer NSAR als Schmerzmittel unmittelbar präoperativ kontraindiziert. Als alternative Analgetika für NSAR können Paracetamol, Cyclooxygenase-2(COX-2)-Hemmer, Tilidin-Naloxon oder Tramadol, die keine weiteren Hämostasestörungen verursachen, perioperativ eingesetzt werden [4,5]. …”

Section: Präoperative Führungunclassified

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Präinterventionelle Änderung der Gerinnungsmedikation

Koscielny

Rutkauskaite

2013

Visc Med

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Hintergrund: Die Differentialdiagnostik und Therapie von perioperativen Blutungen besitzt besonders bei Eingriffen mit hohen Blutverlusten einen hohen Stellenwert, z.B. in der Viszeralchirurgie. Insbesondere die präoperative Erfassung von hämorrhagischen Diathesen und einer gerinnungshemmenden Medikation trägt effektiv zur Minimierung von Komplikationen wie Hämatomen, sekundären Infektionen und Blutverlusten bei. Methode: Pharmakologische Aspekte, bereits vorliegende Konsensus-Empfehlungen und Leitlinien, Erfahrungen sowie Empfehlungen der Hersteller und der Zulassungsbehörden wurden genutzt. Ergebnisse: Bei Elektiveingriffen unter Langzeitantikoagulation ist zur Normalisierung des Blutungsrisikos bei normaler Nieren- und Leberfunktion ein Absetzen der Gerinnungsmedikation vor der Operation ausreichend, ein längerer Abstand ist bei eingeschränkter Nieren- und Leberfunktion sowie bei hohem Lebensalter zu berücksichtigen. Bei Patienten mit positiver standardisierter Blutungsanamnese durch die Einnahme von gerinnungshemmenden Medikamenten sollte auf der Basis einer individuellen Nutzen-Risiko-Abwägung (Individualmedizin) interdisziplinär das perioperative Weiterführen oder Absetzen von Gerinnungshemmern festgelegt werden. Da die Halbwertszeit aber interindividuell unterschiedlich und zum Teil unvorhersehbar sein kann, insbesondere bei Patienten mit verminderter Elimination (z.B. Niereninsuffizienz), kann in Einzelfällen ein geeigneter laboranalytischer Wirkungsnachweis als zusätzliche Entscheidungshilfe die Terminierung der Intervention unterstützen. Aus hämostaseologischer Sicht besteht die Indikation zum bereits präoperativen Management einer hämorrhagischen Diathese. Die Maßnahmen richten sich nach der jeweiligen Defizienz. Schlussfolgerungen: Elektive Eingriffe müssen sorgfältig geplant werden, besonders bei Patienten mit Gerinnungsmedikation oder hämorrhagischer Diathese.

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Präoperative Blutungsanamnese

Cited by 123 publications

References 21 publications

On the value of routine prothrombin time screening in elective neurosurgical procedures

On the value of routine prothrombin time screening in elective neurosurgical procedures

Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis

Präinterventionelle Änderung der Gerinnungsmedikation

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