Koagulopathien bei Hund und Katze^[*]

Zusammenfassung:

Der Gerinnungsprozess findet in drei Phasen statt, der primären und sekundären (plasmatischen) Hämostase sowie der Gerinnungsinhibition/Fibrinolyse. Nach der neueren Definition von Koagulopathien werden diese in „Minus-Koagulopathien“ (= verminderte sekundäre Hämostase) und „Plus-Koagulopathien“ (= Thrombophilie, d. h. Thromboseneigung) unterteilt. Minus-Koagulopathien können angeboren oder erworben sein. Die wichtigsten angeborenen Koagulopathien beim Hund umfassen Faktor-VIIIund FaktorIX-Mangel (Hämophilie A/B). Bei Katzen ist ein Faktor-XII-Mangel bekannt, der jedoch nicht mit ausgeprägten klinischen Symptomen einhergeht. Die häufigste erworbene Minus-Koagulopathie ist die disseminierte intravasale Gerinnung (DIC), gefolgt von Kumarinvergiftung, hochgradigem Leberversagen oder einer Heparintherapie. Die Ätiologie von Plus-Koagulopathien umfasst renalen Proteinverlust, Neoplasien, immunvermittelte Anämie und Vaskulitis. Patienten mit Minus-Koagulopathien zeigen klinisch Hämatome, Epistaxis und Blutungen in Körperhöhlen. Dagegen sind Erkrankungen der primären Hämostase durch Petechien/Ekchymosen charakterisiert. Die Symptome von Störungen der Gerinnungsinhibition sind vielfältig und von der Lokalisation der Thrombusbildung abhängig. Die Patienten können Lahmheit (bei Aortenthrombose) oder Dyspnoe im Fall einer Lungenembolie zeigen. Die wichtigsten diagnostischen Tests bei Patienten mit Blutungsneigung sind die Bestimmung der Thrombozytenzahl sowie eine Messung der Thromboplastinzeit (PT) und aktivierten partiellen Thromboplastinzeit (aPTT). Bei Hunden mit Verdacht auf DIC sollten zusätzlich D-Dimere und Fibrinogen bestimmt werden. Ein erhöhter D-Dimer-Wert ist Anzeichen einer Lyse quervernetzter Fibringerinnsel und kann auch bei Hunden mit Thromboembolien, vorangegangenen chirurgischen Eingriffen oder Blutungen in Körperhöhlen auftreten. Die Therapie von Koagulopathien ist variabel und abhängig von der Ätiologie der Erkrankung.

Summary

Coagulation consists of three phases, primary haemostasis and secondary (plasmatic) haemostasis, as well as the inhibition of haemostasis/fibrinolysis. Different definitions of coagulopathies exist. According to the more recent definition of coagulopathies, they are divided up into “minus coagulopathies” and “plus coagulopathies”. “Minus coagulopathies” are defined as reduced secondary haemostasis, whereas “plus coagulopathies” are consistent with thrombophilia i. e., the risk of thrombosis. Minus coagulopathies may be congenital or acquired. The most important congenital coagulopathies in dogs include Factor VIII and IX deficiency (haemophilia A/B). In cats, Factor XII deficiency has been established, however, it is not associated with severe clinical signs. The most important acquired minus coagulopathy is disseminated intravascular coagulation (DIC) followed by cumarin intoxication, severe liver failure or treatment with heparin. The aetiology of plus coagulopathies includes renal protein lost, neoplasia, immune mediated anaemia, and vasculitis. Clinical signs of patients with minus coagulopathies are haematoma, epistaxis, or haemorrhage in body cavities. In contrast to this, primary haemostasis disorders are characterized by petechiae/ecchymoses. There are various signs of disorders in the inhibition of coagulation/fibrinolysis, i. e. thrombosis, depending on the site of thrombus formation. They may include lameness (aortic thrombosis) or dyspnea in the case of pulmonary thromboembolism. Important diagnostic tests for patients with bleeding tendency include platelet count, determination of the thromboplastin time (PT), and activated partial thromboplastin time (aPTT). In dogs with suspected DIC, D-dimers and fibrinogen should be measured in addition. Elevated D-dimers indicate fibrinolysis of cross linked fibrin clots and may also be elevated in dogs with thromboembolism, recent surgery or haemorrhage in body cavities. The type of therapy varies and mainly depends on the underlying aetiology of the coagulopathies.

Schlüsselwörter

Hämostase - Fibrinolyse - Globaltests - D-Dimere - Thrombophilie - Thrombose

Key words

Haemostasis - fibrinolysis - global tests - D-dimers - thrombophilia - thrombosis - canine - feline

^* * Als Vortrag präsentiert auf dem 53. Jahreskongress der DGK-DVG, 15.-17.11.2007, Berlin

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