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DOI: 10.1055/s-0031-1277972
© Georg Thieme Verlag Stuttgart · New York
Gerinnungsoptimierung mit ROTEM® – Pro
Coagulation Monitoring using ROTEM: ProPublication History
Publication Date:
10 May 2011 (online)
![](https://www.thieme-connect.de/media/ains/201105/lookinside/thumbnails/10.1055-s-0031-1277972-1.jpg)
Zusammenfassung
Das Gerinnungspotenzial eines kritisch kranken Patienten, unabhängig davon ob es sich um einen akut und massiv blutenden Patienten im Schockraum bzw. im OP oder um einen septischen Patienten im schweren Multiorganversagen auf der Intensivstation handelt, muss schnell und sicher erkannt werden, um eine individuelle und effiziente Therapie einleiten zu können – sei es eine aggressive prokoagulatorische Therapie mittels Einzelgerinnungsfaktorenkonzentraten oder eine potente Antikoagulation. Unter alleiniger Zuhilfenahme von sog. Standardgerinnungstests wie PT (INR), aPTT, Fibrinogen nach Clauss etc. ist dies nur eingeschränkt möglich. In einigen Fällen ist mithilfe dieser Parameter nicht einmal vorhersagbar, ob ein Patient aus hämostaseologischer Sichtweise blutungsgefährdet oder thromboemboliegfährdet ist. Die Thrombelastometrie (ROTEM®) bietet dem klinisch tätigen Anästhesisten und Intensivmediziner in der täglichen Routine die Möglichkeit, schnell und sicher das aktuelle Gerinnungspotenzial zu erfassen und therapeutische Schritte zeitnah kontrollieren zu können.
Abstract
Coagulation and haemostasis in critical ill patients, either in massively bleeding patients in the emergency room and the operating theatre (TIC = trauma induced coagulopathy) or in septic patients suffering from multiorgan failure (DIC = disseminated intravascular coagulopathy) have to be identified and monitored promptly to initiate and monitor an effective therapy – either aggressive therapy using coagulation factor concentrates and blood products or a keen anticoagulation. Under this circumstances, standard coagulation monitoring using PT (INR), aPTT and fibrinogen (Clauss method) is limited. In critical ill patients, these parameters are neither able to predict risk of bleeding nor the risk of thrombosis. New viscoelastic methods like the ROTEM® may help to improve coagulation monitoring and management even in the emergency situation or under critical care conditions.
Schlüsselwörter
Gerinnung - Gerinnungsmonitoring - Thrombelastometrie - Blutung - Thrombose
Keywords
Haemostasis - monitoring - thrombelastometry - bleeding - thrombosis
Kernaussagen
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Die Standardgerinnungstests können bei komplexen Krankheitsbildern weder das Blutungsrisiko noch das Thromboserisiko bei kritisch kranken Patienten anzeigen.
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Die Thrombelastometrie (ROTEM) kann im Gegensatz dazu zwischen Thromboseneigung und Blutungsneigung einfach differenzieren.
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Die Thrombelastometrie liefert im Gegensatz zum Gerinnungslabor innerhalb weniger Minuten Ergebnisse und ist als POC -Gerät im OP oder auf der Intensivstation einsetzbar.
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Mithilfe von speziellen Tests können bei blutenden Patienten bzw. bei blutungsgefährdeten Patienten folgende Pathologien innerhalb weniger Minuten detektiert werden: Fibrinogenpolymerisationsstörungen, Thrombozytopenien, Hyperfibrinolysen, Faktorenmangelzustände und Heparinwirkung.
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Die Methode ist einfach und schnell anwendbar. Mithilfe von sog. „Single-Use-Reagenzien“ werden zusätzliche Pipettierschritte, die zu Fehlern in der Durchführung des Tests führen können, vermieden.
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Eine Hyperfibrinolyse ist derzeit in der klinischen Praxis ausschließlich mit der Methode der Thrombelastografie oder Thrombelastometrie nachweisbar.
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Fibrinogenpolymerisationsstörungen werden im ROTEM besser erkannt als mit der Methode nach Clauss.
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Eine Heparinwirkung kann mittels Heparinase-Zusatz ausgeschlossen werden.
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Folgende Gerinnungspathologien können nicht detektiert werden: orale Antikoagulation, Thrombozytenfunktionsstörungen, Thrombozytenfunktionshemmer.
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Es gibt derzeit in der Literatur Hinweise, dass durch eine Optimierung des Gerinnungsmanagements mithilfe von ROTEM Kosten eingespart werden können.
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A. univ. Prof. Dr. Dietmar Fries
Email: dietmar.fries@i-med.ac.at