Hamostaseologie 2021; 41(04): 294-306
DOI: 10.1055/a-1389-8216
Review Article

Anticoagulation in Critically Ill Adults during Extracorporeal Circulation

Nina Buchtele
1   Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Thomas Staudinger
1   Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Anne-Kristin Schäfer
2   Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
Magdalena Sophie Bögl
3   Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
,
Christian Schoergenhofer
4   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Michael Schwameis
3   Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
› Institutsangaben

Abstract

Extracorporeal circuits including renal replacement therapy, extracorporeal membrane oxygenation, and ventricular assist devices are increasingly used in critically ill patients. The need for anticoagulation to provide circuit patency and avoid thrombosis remains a challenging task for treating physicians. In the presence of overall low scientific evidence concerning the optimal anticoagulants, monitoring tests, and therapeutic target ranges, recommendations are largely expert opinions and most centers use individual “in-house” anticoagulation protocols. This review gives a practical view on current concepts of anticoagulation strategies in patients with extracorporeal assist devices.

Zusammenfassung

Extrakorporale Organersatzverfahren (Nierenersatzverfahren, extrakorporale Membranoxygenierung und ventrikuläre Unterstützungssysteme) finden zunehmend Verwendung in der modernen Notfall- und Intensivmedizin. Die Notwendigkeit einer Antikoagulation, um eine Thrombosierung extrakorporaler Kreisläufe zu verhindern, bleibt jedoch eine Herausforderung für die/den behandelnde/n Ärztin/Arzt. Angesichts der insgesamt schwachen wissenschaftlichen Evidenz bezüglich des optimalen Antikoagulans, optimaler Tests zur Steuerung und anzustrebender therapeutischer Zielbereiche basieren aktuelle Empfehlungen weitgehend auf Expertenmeinungen. Die meisten Zentren verwenden daher eigene ‘hausinterne’ Antikoagulations-Protokolle. Dieses Review soll einen praktischen Überblick über aktuelle Antikoagulationsstrategien bei Patienten/innen mit extrakorporalen Organersatzverfahren geben.



Publikationsverlauf

Eingereicht: 18. Juli 2020

Angenommen: 11. Februar 2021

Artikel online veröffentlicht:
15. April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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