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Laryngorhinootologie 2015; 94(01): 10-17
DOI: 10.1055/s-0034-1382000
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

HNO-Chirurgie bei Patienten unter oraler Antikoagulation und Plättchenhemmer-Therapie

ENT Surgery in Anticoagulate Patients
H. Lapp
1   3. Medizinische Klinik, HELIOS Klinikum Erfurt, Erfurt, Universität Witten/Herdecke
,
A. Neumeister
2   Angiologie, HELIOS Klinikum Erfurt, Erfurt
,
D. Eßer
3   HNO, HELIOS Klinikum Erfurt, Erfurt
› Author Affiliations
Further Information

Publication History

Publication Date:
08 January 2015 (online)

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Zusammenfassung

Einleitung: Patienten unter einer Therapie mit oralen Antikoagulanzien und Plättchenhemmern sind häufig in der elektiven HNO-Chirurgie. ­Einerseits birgt die Fortführung dieser Therapien ein erhöhtes Risiko für Blutungskomplikationen, während andererseits das unkritische Absetzen schwerwiegende thrombembolische Folgen haben kann. Die Zahl der eingesetzten Antikoagulanzien und Plättchenhemmer hat zugenommen. Der operativ tätige HNO-Arzt ist damit regelmäßig mit der Frage Fortsetzung, Beendigung oder Bridging dieser Therapie konfrontiert.

Methoden: Review der verfügbaren Literatur zum Thema Blutungskomplikationen bei HNO-Eingriffen mit und ohne Antikoagulanzien. ­Darstellung der Indikationen zur Therapie mit Antikoagulanzien und der unterschiedlichen Wirkprinzipien und Eigenschaften der einzelnen Substanzen. Erarbeitung von Protokollen zur Risikostratefizierung und zum perioperativen Management.

Schlussfolgerungen: Patienten mit oraler Antikoagulation und Plättchenhemmung haben eine relevante Morbidität und Mortalität aufgrund der zugrunde liegenden Erkrankungen, aber auch ­aufgrund des perioperativen Umgangs mit diesen Therapien. Das perioperative Management dieser Patienten sollte auf der Basis abgestimmter Behandlungspfade oder bei Risikopatienten nach multidisziplinärer Konsultation erfolgen. Obwohl die hier entwickelten Empfehlungen auf evidenzbasierten Daten basieren und so eine Vielzahl klinischer Notwendigkeiten abdecken, können sie nicht die klinische Entscheidung ersetzen, die spezifische Charakteristika und Umstände des individuellen Patienten, des geplanten Eingriffs oder der Infrastruktur des operativen Umfelds berücksichtigen muss.

Abstract

Background: In elective ENT surgery, one frequently sees ­patients on oral anticoagulants and platelet inhibitors. While continuation of these therapies increases the risk of bleeding complications, indiscriminate discontinuation can have severe thromboembolic consequences. Furthermore, the number of ­anticoagulants and platelet inhibitors in use has increased. The ENT-specialist is regulary confronted with the question of continuation, discontinuation, or bridging of this therapy.

Methods: Review of the available literature on bleeding complications associated with ENT interventions performed with and without anticoagulants. Overview of the indications for anticoagulants and the different mechansims of action and properties of the different agents. Development of protocols for risk stratification and for perioperative management.

Conclusions: Patients on oral anticoagulants and platelet inhibitors have significant morbidity and mortality not only due to the underlying diseases, but also due to the perioperative management of these therapies. Perioperative management should be based on well-established treatment guidelines or, in high-risk patients, on multidisciplinary consultation. Even though the recommendations here are evidence-based and cover a multitude of clinical contingencies, they cannot replace clinical decision making, which must consider the specific characteristics and circumstances of the patient, the planned intervention, and the surgical environment.

Schlüsselwörter

perioperatives Management - Antikoagulation - Plättchenhemmer - Blutungen - thromembolische Komplikationen

Key words

perioperative management - anticoagulation - platelet inhibitors
 

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