Untersuchungen �ber Blutgerinnungsst�rungen nach Thoraxoperationen

Abstract

A Contribution to the Question o/ImTending Postoperative Thrombosis and Embolism~ummary. In the introduction reasons for the assumption are discussed that studies of blood coagulation following chest surgery offer the possibility of gaining clues about the danger of postoperative thromboembolism. Studies were performed on a total of 50 patients; 40 of whom underwent thoracic procedures (cardiac surgery under normal anesthesia, in hypothermia, and in extraeorporeal circulation as well as pulmonary resections), the remaining 10 different operations outside of the thorax served as controls. The scale of the physiologic studies of the blood clotting covered the determination of the factors II, V, VII, VIII and X, the thrombinetime, the antithrombine, the fibrinolysis, the thrombelastogram and the platelet count. The clotting analysis was done daily during the first 8 postoperative days, alternating during the second week and twice during the third week. The following main results were obtained: t. Aa initial drop in activity of the factors II, V, VII and X, a strong increase in activity of the factor VIII, in the thrombelastogram a shortening in the reaction-and the clotting time, an increase in the maximal thrombelasticity, furthermore an increase of the platelet count and a decrease of the fibrinolysis activity. 2. In cardiac operations a more emphasized change in the clotting mechanism oceured than in the other operations. 3. The greatest deviation of the clotting mechanism was observed during the first postoperative week, which normalised during 3 weeks. It is concluded that the described changes of blood coagulation point during the first postoperative week toward an increased blood clotting tendency. With a hypcrcoagulability of the clotting mechanism a precondition is given for the onset of thromboembolic complications.Zusammen]assung, In der Einleitung wird die Annahme begriindet, dal3 Untersuchungen der Blutgerinnung im AnschluB an Thoraxeingriffe in besonderem FfaBe die Chance bieten, AnhMtspunkte fiir eine postoperative Thromboemboliege-f~hrdung zu gewinnen. Die Untersuehungen wurden bei insgesamt 50 Kranken vor-* Mit freundlieher Unterstiitzung der Deutschen Forschungsgemeinsch~ft.

Richtlinien zur Thromboseprophylaxe in der Chirurgie

“…3. Die postoperative Hyperkoagulabilität ist die Ursache sowohl von Thrombosen und Lungenembolien als auch von postoperativen Blutungen (5,9). Die postoperative Hyperkoagulabilität wird durch Thrombozytenzerfall und die Einschwemmung von Gewebsaktivatoren in die…”

“…Blutbahn hervorgerufen. Die intraoperativ entstehende Stagnation des Blutes in Peripherie und parenchymatösen Organen, die Hypoxie, eine Acidose unterschiedlichen Ausmaßes und die Hyperkoagulabilität (5,9) sind als eine Kettenreaktion aufzufassen, die zu Mikrozirkulationsstörungen führt. Die Folge sind dann intravasale Mikro-und Makrothromben, die wieder zu embolischen Schüben und über den kompensatorischen Verbrauch von Gerinnungsfaktoren in eine hämorrhagische Diathese überleiten (2, 3, 4).…”