Perioperative Diagnostik und Management von Hyperkoagulabilität und Thrombophilie in der Mikrochirurgie – Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM)

Zusammenfassung

Der regelrechte Blutfluss durch mikrochirurgisch anastomosierte Gefäße ist für den Therapieerfolg der rekonstruktiven Mikrochirurgie post operationem entscheidend. Im Gegensatz zu inzwischen in weiten Teilen ausgereiften und standardisierten Anastomosentechniken steht die erfolgsentscheidende Partnerdisziplin der evidenzbasierten mikrochirurgischen Hämostaseologie und Hämorheologie allerdings noch am Anfang. Prospektive klinische Studien und daraus ableitbare evidenzbasierte Empfehlungen fehlen. Lediglich standortspezifische Erfahrungswerte bilden heutzutage die Grundlage des perioperativen Managements in der Mikrochirurgie. Gemeinsames Ziel dieser mannigfaltigen Bemühungen sind die präoperative Identifikation erhöhter Gerinnungsneigungen (Hyperkoagulabilität) oder Gerinnungsaktivitäten (Thrombophilie) und die Formulierung korrespondierender Antikoagulationsregime. Im Zuge der 43. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM) im November 2022 in Frankfurt wurden Grundlagen der Gerinnung und Physiologie von Experten der Mikrochirurgie, Hämostaseologie und Anästhesie diskutiert, sowie zusammen mit einem Literaturüberblick Konsensusempfehlungen für das perioperative Management von Hyperkoagulopathien erarbeitet. Im Anschluss wurden im Gremium Vorgehensweisen evaluiert, Entscheidungskriterien erfragt und schließlich ein Empfehlungskonsens der DAM bzgl. eines perioperativen Algorithmus erarbeitet, der in diesem Positionspapier festgehalten ist.

Abstract

Uninterrupted blood flow through microsurgically anastomosed vessels is crucial for the postoperative success of reconstructive microsurgery. Contrary to the highly standardized anastomosis techniques, the pivotal partner discipline of evidence-based microsurgical haemostaseology and haemorrheology is still in its infancy. Prospective clinical studies yielding evidence-based recommendations are notably lacking. Currently, perioperative management in microsurgery is based solely on site-specific empirical experience. The collective aim of these diverse efforts is the preoperative identification of increased coagulation (hypercoagulability) or clotting activities (thrombophilia) and the development of relevant anticoagulation strategies. During the 43rd Annual Meeting of the German-Speaking Working Group for Microsurgery (DAM) in November 2022 in Frankfurt, experts in microsurgery, haemostaseology, and anaesthesia deliberated on the fundamentals of coagulation and physiology. Also, alongside a literature review, consensus recommendations for the perioperative management of hypercoagulopathies were established. Subsequently, methodologies were assessed within the panel, criteria for decision-making were gathered, and, ultimately, a consensus recommendation by DAM regarding a perioperative algorithm was devised, which is detailed in this position paper.

Schlüsselwörter

freie Lappenplastiken<Mikrochirurgie - Anästhesie<Sonstige Aspekte - Arterien<Körperregion und Anatomie - Patientensicherheit

Keywords

free flaps - anaesthesia - arteries - patient safety

^‡ Geteilte Letztautorenschaft

Publikationsverlauf

Eingereicht: 01. Dezember 2024

Angenommen: 26. Januar 2025

Artikel online veröffentlicht:
03. April 2025

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