Thromboseprophylaxe in der bariatrischen Chirurgie

Zusammenfassung

Patienten der bariatrischen Chirurgie sind eine Hochrisikogruppe für venöse Thromboembo-lien. Die aktuellen Leitlinien der AWMF (Deutschland), NICE (Großbritannien) und der ACCP (USA) werden vorgestellt, und es erfolgt eine Diskussion der Literatur zum Thema. Frühmobilisation und physikalische Methoden sind die Basismaßnahmen zur Thromboseprophylaxe für alle Patienten. Zusätzlich ist in der Regel eine medikamentöse Prophylaxe indiziert. Mittel der Wahl sind heute niedermolekulare Heparine. Evidenz-basierte Dosisempfehlungen für bariatrische Patienten liegen nicht vor. Wir empfehlen eine viertel therapeutische Dosis von niedermolekularen Heparinen ohne Gewichts-Obergrenze einmal täglich s.c. Der Beginn soll am Tag vor der OP sein. Alternative ist Fondaparinux in einer Fixdosis von 1 x 2,5 mg s.c. Gegen das Thrombose- muss individuell das Blutungsrisiko abgewogen werden.

Schlüsselwörter

Thromboseprophylaxe - venöse Thromboembolie - bariatrische Chirurgie - Allgemeinchirurgie - niedermolekulares Heparin

• Literatur

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