Download PDF
Hamostaseologie 1996; 16(04): 220-226
DOI: 10.1055/s-0038-1656661
Übersichtsarbeiten/Review Articles
Schattauer GmbH

Reokklusionsprophylaxe im Kindesalter

Sabine Becker
1   Klinikum der Johann-Wolfgang-Goethe-Universität, Zentrum der Kinderheilkunde und Jugendmedizin, Klinik für Kinderheilkunde III - Pädiatrische Hämatologie und Onkologie (Leiter: Prof. B. Kornhuber), Frankfurt a. M.
,
Christine Heller
1   Klinikum der Johann-Wolfgang-Goethe-Universität, Zentrum der Kinderheilkunde und Jugendmedizin, Klinik für Kinderheilkunde III - Pädiatrische Hämatologie und Onkologie (Leiter: Prof. B. Kornhuber), Frankfurt a. M.
,
Elisabeth Lenz
2   Universitätskinderklinik Göttingen
,
W. Kreuz
1   Klinikum der Johann-Wolfgang-Goethe-Universität, Zentrum der Kinderheilkunde und Jugendmedizin, Klinik für Kinderheilkunde III - Pädiatrische Hämatologie und Onkologie (Leiter: Prof. B. Kornhuber), Frankfurt a. M.
› Author Affiliations
Further Information

Publication History

Publication Date:
24 July 2018 (online)

Also available at
  PDF Download  Permissions and Reprints

Zuammenfassung

Für eine erfolgreiche Lysetherapie bei venösen und arteriellen thrombotischen Verschlüssen ist eine Reokklusionsprophylaxe essentiell. Dabei ist ein möglichst frühzeitiger Beginn - parallel zur Lysetherapie - wichtig. Als Adjuvans zu den Fibrinolytika werden bei Erwachsenen neben unfraktioniertem Heparin auch niedermolekulare Heparine (LMWH) eingesetzt; letztere scheinen zumindest gleich wirksam bei etwas geringerem Blutungs- und Nebenwirkungsrisiko. Nach venösen Thrombosen im Kindesalter werden zur Langzeitprophylaxe Cumarinderivate eingesetzt. Bei Kontraindikationen für Cumarin könnten sich niedermolekulare Heparine (LMWH) in Zukunft als vielversprechende Alterna-tiven auch für pädiatrische Patienten erweisen. Allerdings gibt es noch keine Daten zum Osteoporoserisiko unter Langzeitgabe von LMWH; speziell im Kindesalter sollten Nutzen und Risiken für diese Substanzen sorgfältig abgewogen werden. Die Reokklusionsprophylaxe arterieller Gefäße stellt eine Indikation in erster Linie für Azetylsalizylsäure neben unfraktioniertem Heparin und LMWH dar. Im Gegensatz zum Erwachsenenalter werden bei Kindern alle Dosierungen an das Körpergewicht oder die Körperoberfläche angepaßt.

Schlüsselwörter

Thrombose - Reokklusion - Prophylaxe - Kinder
 

  • LITERATUR

  • 1 Agnelli G, Pascucci C, Cosmi B, Nenci GG. The comparative effects of recombinant hirudin (CGP 39393) and standard heparin on thrombus growth in rabbits. Thromb Haemost 1990; 63: 204-7.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Albers GW. Antithrombotic agents in cerebral ischemia. Am J Cardiol 1995; 75: 34-B-38B.
    CrossrefPubMedGoogle Scholar
  • 3 Anderson DR, Brill Edwards P, Walker IR. Warfarin-induced skin necrosis in two patients with protein S deficiency; successful reinstatement of warfarin therapy. Blood 1989; 74 Suppl 409
    PubMedGoogle Scholar
  • 4 Andrew M, Michele D, Magaret A. et al. Venous thromboembolic complications (VTE) in children: first analysis of the Canadian Registry of VTE. Blood 1994; 83: 1251-7.
    CrossrefPubMedGoogle Scholar
  • 5 Andrew M, Schmidt B. Use of heparin in newborn infants. Semin Thromb Hemost 1988; 14: 28-32.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Antman EM. Hirudin in acute myocardial infarction. Safety report from the Thrombolysis and Thrombin Inhibition in Myocardial Infarction (TIMI) 9A Trial. Circulation 1994; 90: 1624-30.
    CrossrefPubMedGoogle Scholar
  • 7 Barrowcliff TW, Curtis AD, Tomlinson TP. et al. Standardization of low molecular weight heparins: A collaborative study. Thromb Haemost 1985; 54: 675-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Beeser H. Überwachung der Behandlung mit Cumarinderivaten. In: Thrombophilie und Antikoagulation. XXXVI. Hamburger Symposium über Blutgerinnung am 11. + 12.6.1993. Tilsner V, Matthias F. (Hrsg). Edition Roche 1994; 103-17.
    PubMedGoogle Scholar
  • 9 Bengtsson-Olivecrona G, Olivecrona T. Binding of active and inactive forms of lipoproteinlipase to heparin. Biochem J 1985; 226: 406-8.
    PubMedGoogle Scholar
  • 10 Bjornsson TO, Wolfram BS, Kitchell BB. Heparin kinetics determined by three assay methods. Clin Pharmacol Ther 1982; 31: 104-13.
    CrossrefPubMedGoogle Scholar
  • 11 Boss JM, Summerly R. Prevention of warfarin-induced skin necrosis. Br J Dermatol 1979; 100: 617-20.
    CrossrefPubMedGoogle Scholar
  • 12 Breddin HK, Grun H, Krzywanek HJ, Schremmer WP. Zur Messung der »spontanen« Thrombozytenaggregation. Plättchen-aggregationstest III. Methodik Klin Wo-chenschr 1975; 53: 81-9.
    PubMedGoogle Scholar
  • 13 Broekmans AW, Bertina RM, Loelinger EA. et al. Protein C and the development of skin necrosis during anticoagulant therapy. Thromb Haemost 1983; 49: 251-55.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Chong BH, Berndt MC. Heparin-induced thrombocytopenia. Blut 1989; 58: 53-7.
    CrossrefPubMedGoogle Scholar
  • 15 Coller B. Platelets and thrombolytic therapy. N Engl J Med 1990; 322: 33-42.
    CrossrefPubMedGoogle Scholar
  • 16 Eisenberg PR. Mechanisms of reocclusions after coronary thrombolysis. Z Kardiol 1993; 82 (Suppl. 02) 175-8.
    PubMedGoogle Scholar
  • 17 Eisenberg PR, Sherman LA, Jaffe AS. Paradoxic elevation of fibrinopeptide A: evidence for continued trombosis despite intensive fibrinolysis. J Am Coll Cardiol 1987; 10: 527-9.
    CrossrefPubMedGoogle Scholar
  • 18 Eisenberg PR, Sherman LA, Rich M. et al. Importance of continued activation of thrombin reflected by fibrinopeptide A to the efficacy of thrombolysis. J Am Coll Cardiol 1986; 7: 1255-62.
    CrossrefPubMedGoogle Scholar
  • 19 Eisenberg PR, Sobel BE, Jaffe AS. Activation of prothrombin accompanying thrombolysis with rt-PA. J Am Coll Cardiol 1992; 19: 1065-9.
    CrossrefPubMedGoogle Scholar
  • 20 Ginsberg JS, Kowalchuk G, Hirsh J. Heparin effect on bone density. Thromb Haemost 1990; 64: 286-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Greinacher A, Eichler P. Die Heparin-assoziierte Thrombozytopenie - Immunologische Aspekte. Hämostaseologie 1995; 15: 117-21.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Gruber A, Harker LA, Hanson SR. et al. Antithrombotic effects of combining activated protein C and urokinase in nonhuman primates. Circulation 1991; 84: 2454-62.
    CrossrefPubMedGoogle Scholar
  • 23 Gulba DC, Westhoff-Bleck M, Jost S. et al. Increased thrombin levels during thrombolytic therapy in acute myocardial infarction. Circulation 1991; 83: 937-44.
    CrossrefPubMedGoogle Scholar
  • 24 Harenberg J. Pharmacology of low molecular weight heparins. Semin Thromb Hemost 1990; 16 Suppl 12-8.
    PubMedGoogle Scholar
  • 25 Harenberg J, Giese CH, Dempfle CE. et al. Biological activity and safety of the subcutaneous administration of high doses of low molecular weight heparin for 8 days in human volunteers. Thromb Haemost 1989; 61: 357-62.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Harenberg J, Giese CH, Knödler A. et al. Neutralization of a low molecular weight heparin Kabi 2165 by protamine chloride. Klin Wochenschr 1986; 64: 1171-5.
    CrossrefPubMedGoogle Scholar
  • 27 Harenberg J, Gnasso HA, De Vries JX. et al. Inhibition of low molecular weight heparin by protamin chlorid in vivo. Thromb Res 1985; 38: 11-20.
    CrossrefPubMedGoogle Scholar
  • 28 Harenberg J, Roebruck P, Heene DL. and the HESIM-Group. Subcutaneous low molecular mass heparin (1mm) against un-fractionated (UF) heparin for prophylaxis of thromboembolism in medical patients. Ann Hematol 1994; 69 (Suppl II) A55 Abstr. 51
    PubMedGoogle Scholar
  • 29 Harenberg J, Leber G, Dempfle CE. et al. Long term anticoagulation with low molecular weight heparin in outpatients with side effects on oral anticoagulants. Nouc Rev Franc Hematol 1989; 31: 363-9.
    PubMedGoogle Scholar
  • 30 Harker LA. Antithrombotic strategies for resistant thrombo-occlusive events. Biomedical progress 1995; 8: 17-27.
    PubMedGoogle Scholar
  • 31 Harker LA, Gent M. Antiplatelet agents in the management of thrombotic disorders. In: Hemostasis and Thrombosis: Basic Principles and Clinical Practise. . Colman RW. et al. (eds). Philadelphia: JB Lippincott; 1994: 1506
    Google Scholar
  • 32 Harker LA, Maraganore JM, Hirsh J. Novel antithrombotic agents. In: Hemostasis and Thrombosis: Basic Principles and Clinical Practise. Colman RA. et al. (eds). Philadelphia: JB Lippincott; 1994: 1651
    Google Scholar
  • 33 Hass WK, Easton JD, Adams HP. et al. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high risk patients. N Engl J Med 1989; 321: 501-7.
    CrossrefPubMedGoogle Scholar
  • 34 Hirsh J, Buchanan MR. Comparative effects of heparin and LMW heparin on hemostasis. Thromb Res Suppl 1991; 14: 11-7.
    PubMedGoogle Scholar
  • 35 Holmer E, Kurachi K, Söderström G. The molecular-weight dependence of the rate-enhancing effect of heparin on the inhibition of thrombin, factor Xa, factor XIa, factor Xlla and kallikrein by antithrombin. Biochem J 1981; 395: 400-7.
    PubMedGoogle Scholar
  • 36 Hull R, Hirsh J, Jay R. et al. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med 1982; 307: 1676-81.
    CrossrefPubMedGoogle Scholar
  • 37 Hull RD, Raskob GE, Pineo GF. et al. Subcutaneous low-molecular-weight-hepa-rin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. N Engl J Med 1992; 326: 975-82.
    CrossrefPubMedGoogle Scholar
  • 38 Kakkar VV. An international multicentre trial. Prevention of fatal postopertive pulmonary embolism by low doses of heparin. Lancet 1975; I: 45-51.
    PubMedGoogle Scholar
  • 39 Kreuz W, Heller C, Lenz E. Thrombolyse mit rt-PA im Kindesalter - eine Übersicht. Fibrinolyse 1996; 1/2: 4-10.
    PubMedGoogle Scholar
  • 40 Lechler E, Schramm W, Flosbach SW. and The Prime-Study-Group. A randomized double blind study investigating the efficacy and safety of the low molecular weight heparin enoxaparin versus unfractionated heparin in the prevention of thromboembolism in immobilised medical patients. Ann Hematol 1994; 69 (Suppl II) A55 Abstr. 52
    PubMedGoogle Scholar
  • 41 Leiber G, Egbrink R. Zur Therapie der »Cumarinnekrose«. Internist 1972; 13: 340-3.
    PubMedGoogle Scholar
  • 42 Leizorovicz A, Simmoneau G, Decousus H, Boissel JP. Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep vein thrombosis: a meta-analysis. Br Med J 1994; 309: 299-304.
    CrossrefPubMedGoogle Scholar
  • 43 Lensing AWA, Prins MH, Davidson BL, Hirsh J. Treatment of deep venous thrombosis with low-molecular-weight heparins. A meta-analysis. Arch Intern Med 1995; 155: 601-7.
    CrossrefPubMedGoogle Scholar
  • 44 Lenz E, Heller C, Schröter W, Kreuz W. Reocclusion prophylaxis after venous thrombosis or arterial thromboembolic event in children. Ann Hematol 1996; 72 (Suppl I) A64
    PubMedGoogle Scholar
  • 45 Loeliger EA. ICSH/ISTH recommendations for reporting prothrombin time in oral anticoagulant control. Thromb Haemost 1985; 53: 155-7.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Loeliger EA, Van Den Besselaar AMHP. Thromboplastin Calibration and Oral Anticoagulant Control. Boston, The Hague, Dordrecht, Lancaster: Martin Nijhoff Publishers 1984; 2-9.
    PubMedGoogle Scholar
  • 47 Magnani HN. Heparin-induced thrombocytopenia: an overview of 230 patients treated with orgaran (Org 10172). Thromb Haemost 1993; 70: 554-61.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Marbert GA, Duckert F. The development of thrombolytic treatment in venous thrombosis. Experience with streptokinase-based regimens. Vasa 1986; 15: 359
    PubMedGoogle Scholar
  • 49 Massonnet-Castel S, Pelissier E, Bara L. et al. Partial reversal of low-molecular-weight heparin (PK 10169) Anti Xa Activity by protamine sulfate: In vitro and in vivo study during cardiac surgery with extracorporal circulation. Haemostasis 1986; 16: 139-45.
    PubMedGoogle Scholar
  • 50 Mc Donald MM, Jacobson LJ, Hay WW, Hathaway WE. Heparin clearance in the newborn. Ped Res 1981; 15: 1015-8.
    CrossrefPubMedGoogle Scholar
  • 51 McGehee WG, Klotz TA, Epstein DJ, Rapaport S. l. Coumarin necrosis associated with hereditary protein C deficiency. Ann Intern Med 1984; 100: 59-63.
    CrossrefPubMedGoogle Scholar
  • 52 Melissari E, Paker CJ, Wilson NV. et al. Use of low molecular weight heparin in pregnancy. Thromb Haemost 1992; 68: 652-6.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Minar E, Ehringer H, Hirschl M. Trans-aminasenanstiege: eine weitgehend unbekannte Nebenwirkung der Heparintherapie. Dtsch Med Wochenschr 1980; 105: 1713-4.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Monreal M, Lafoz E, Olive A. et al. Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin®) in patients with venous thromboembolism and contraindications to coumarin. Thromb Haemost 1994; 71: 7-11.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 55 Neuhaus KL, von Essen R, Tebbe U. et al. Safety observations from the pilot phase of the randomized r-Hirudin for Improvement of Thrombolysis (HIT III) study. A study of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK). Circulation 1994; 90: 1638-42.
    CrossrefPubMedGoogle Scholar
  • 56 Okajma Y, Kayama S, Maeda Y. et al. Studies on the neutralizing mechanism of antithrombin activity of heparin by protamine. Thromb Res 1981; 24: 21-9.
    CrossrefPubMedGoogle Scholar
  • 57 O' Reilly RA. Warfarin metabolism and drug-drug interaction. In: The New Dimensions of Warfarin Prophylaxis. . Wessler S, Becker CG, Nemerson Y. (eds). Volume 214 of Advances in Experimental Medicine and Biology. New York: Plenum; 1986: 205-12
    Google Scholar
  • 58 Pineo GF, Hull RD, Rosenbloom D. et al. A cost-effectiveness analysis using actual costs of low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. Int Angiology 1994; 13 (Suppl.I) Abstr 87
    PubMedGoogle Scholar
  • 59 Rapold HJ. Promotion of thrombin activity by thrombolytic therapy without simultaneous anticoagulation. Lancet 1990; 1: 481-2.
    PubMedGoogle Scholar
  • 60 Rapold HJ, Weiss M, Baur H, Haeberli A. Monitoring of fibrin generation during thrombolytic therapy of acute myocardial infarction with recombinant tissue type plasminogen activator. Circulation 1989; 79: 980-9.
    CrossrefPubMedGoogle Scholar
  • 61 Rasche H. Heparine: Abhängigkeit der Wirkung von Antithrombin, Molekulargewicht und Dosis. In: Thrombophilie und Antiko-agulation. XXXVI. Hamburger Symposium über Blutgerinnung am 11. + 12.6.1993. Tilsner V, Matthias F. (Hrsg). Edition Roche 1994; 23-32.
    PubMedGoogle Scholar
  • 62 Roth GJ, Majerus PW. The mechanism of the effect of aspirin on human platelets. J Clin Invest 1975; 56: 624-8.
    CrossrefPubMedGoogle Scholar
  • 63 Schmidt B, Buchanan MR, Ofosu F. et al. Antithrombotic properties of heparin in a neonatal piglet model of thrombin-induced thrombosis. Thromb Haemost 1988; 60: 289-92.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 64 Schmidt B, Mitchell L, Ofosu F. et al. Standard assays underestimate the concentration of heparin in neonatal plasma. J Lab Clin Med 1988; 112: 641-3.
    PubMedGoogle Scholar
  • 65 Schmidt B, Ofosu A, Mitchell L. et al. Anticoagulant effects of heparin in neonatal plasma. Pediatr Res 1989; 25: 405-8.
    CrossrefPubMedGoogle Scholar
  • 66 Sehnert W, Hackenberg K, Bierfert E. Fibri-nolysetherapie bei Cumarinnekrosen. Dtsch Med Wochenschr 1982; 107: 515-9.
    PubMedGoogle Scholar
  • 67 Stamm H. Antikoagulantien-Nekrosen. Fortschr Geburtsh Gynäkol 1969; 39: 57-60.
    PubMedGoogle Scholar
  • 68 Terres W, Lund GK, Hübner A. et al. Endogenous tissue plasminogen activator and platelet reactivity as risk factors for reocclusion after recanalization of chronic total coronary occlusions. Am Heart J 1995; 130: 711-6.
    CrossrefPubMedGoogle Scholar
  • 69 Theiss W. Thrombolysetherapie tiefer Venenthrombosen. Indikationsstellung, Behandlungsverfahren. Internist 1992; 33: 225-31.
    PubMedGoogle Scholar
  • 70 Theroux P, Perez-Villa F, Waters D. et al. Randomized double-blind comparison of two doses of Hirulog with heparin as adjunctive therapy to streptokinase to promote early patency of the infarct-related artery in acute myocardial infarction. Circulation 1995; 91: 2132-9.
    CrossrefPubMedGoogle Scholar
  • 71 US Pharmacopeia, 20th rev, US Pharmaco-peial Convention, Rockville, MD. 1980: 686
    Google Scholar
  • 72 Van den Besselaar AMHP. The significance of the international normalized ratio (INR) for oral anticoagulant therapy. JIFCC 1991; 3: 146-51.
    PubMedGoogle Scholar
  • 73 Wankmüller H, Ellbrück D, Seifried E. Pathophysiologie, Klinik und Therapie der Cumarin-Nekrose. Dtsch Med Wochenschr 1991; 116: 1322-30.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 74 Warkentin TE, Kelton JG. Heparin-induced thrombocytopenia. Prog Hemost Thromb 1991; 10: 1-34.
    PubMedGoogle Scholar
  • 75 Warkentin TE, Levine MN, Roberts RS. et al. Heparin-induced thrombocytopenia is more common with unfractionated heparin than with low molecular weight heparin. Thromb Haemost 1993; 69: 911-7.
    PubMedGoogle Scholar
  • 76 Warkentin TE, Levine MN, Hirsh J. et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332: 1330-5.
    CrossrefPubMedGoogle Scholar
  • 77 Wehmeier A, Schneider W. Thrombozyten-funktionshemmung als therapeutisches Prinzip. Inn Med 1985; 12: 187-95.
    PubMedGoogle Scholar
  • 78 White RH, Mc Curdy SA, von Marensdorff H. et al. Home prothrombin time monitoring after the initiation of warfarin therapy. A randomised prospective study. Ann Intern Med 1989; 111: 730-7.
    CrossrefPubMedGoogle Scholar