Point-of-Care-Gerinnungsdiagnostik in der Neurochirurgie

Zusammenfassung

Gerinnungsstörungen können für neurochirurgische Patienten gravierende Auswirkungen auf den Krankheitsverlauf und das Outcome haben: Blutungskomplikationen können zu intrakraniellem Druckanstieg und Schädigung des Gehirns führen. Somit hat die Gerinnungsdiagnostik und ggf. -therapie hier einen hohen Stellenwert. Dieser Beitrag beleuchtet die Anwendung moderner Point-of-Care-Verfahren zur Gerinnungsdiagnostik bei neurochirurgischen Patienten.

Abstract

Disorders of the coagulation system can seriously impact the clinical course and outcome of neurosurgical patients. Due to the anatomical location of the central nervous system within the closed skull, bleeding complications can lead to devastating consequences such as an increase in intracranial pressure or enlargement of intracranial hematoma. Point-of-care (POC) devices for the testing of haemostatic parameters have been implemented in various fields of medicine. Major advantages of these devices are that results are available quickly and that analysis can be performed at the bedside, directly affecting patient management. POC devices allow identification of increased bleeding tendencies and therefore may enable an assessment of hemorrhagic risks in neurosurgical patients. Although data regarding the use of POC testing in neurosurgical patients are limited, they suggest that coagulation testing and hemostatic therapy using POC devices might have beneficial effects in this patient population. This article provides an overview of the application of point-of-care coagulation testing in clinical practice in neurosurgical patients.

Kernaussagen

• Neurochirurgische Patienten sind durch Blutungskomplikationen besonders gefährdet.

• Bei hohen perioperativen Blutverlusten nach neurochirurgischen Eingriffen sollten viskoelastische Verfahren zum Einsatz kommen.

• Die Anwendung einer POC-Gerinnungsdiagnostik wird im Rahmen der Behandlung von Traumapatienten (mit SHT) auf Basis eines Expertenkonsenses in Leitlinien empfohlen.

• Für Patienten mit einer ICB oder einem SDH unter OAK kann die POC-Gerinnungsdiagnostik sinnvoll sein, um eine frühzeitige hämostatische Therapie einzuleiten.

• Zur Therapieüberwachung einer antithrombozytären Medikation nach neuroendovaskulären Verfahren kann der Einsatz der POC-Gerinnungsdiagnostik hilfreich sein.

Schlüsselwörter

Point-of-Care-Gerinnungsdiagnostik - intrakranielle Blutung - Koagulopathie - Schädel-Hirn-Trauma

Key words

Point-of-care coagulation testing - intracranial hemorrhage - coagulopathy - traumatic brain injury

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