Die Bedeutung thrombophiler Risikofaktoren bei Patienten mit arteriellen Thrombosen

Zusammenfassung

Für das arterielle Gefäßsystem sind Risikofaktoren der Thrombophilie weniger klar charakterisiert als die klassischen Risikofaktoren der Atherosklerose oder die Risikofaktoren der Thrombophilie im venösen Gefäßsystem. Die Bewertung wird erschwert durch eine bisher unzureichende Trennung zwischen (a) proatherosklerotischen und prothrombogenen Effekten (z. B. thrombozytäre Rezeptor - polymorphismen) und (b) reaktiven Veränderungen eines Hämostaseparameters (z. B. PAI-1, Fibrinogen) als Ausdruck einer Akute-Phase-Reaktion und primär hereditären Veränderungen derartiger Risikodeterminanten. Die Studienlage zeigt für die Mehrzahl der potenziellen Risikofaktoren nur ein geringgradig erhöhtes relatives Risiko für ein arteriell ischämisches Ereignis und ist häufig auch inkonsistent. Dies schließt allerdings eine Bedeutung potenziell thrombophiler Risikodeterminanten für den arteriellen Gefäßverschluss nicht aus. Ursache hierfür könnte sein, dass konventionelle Fall-Kontroll-Studien nicht ausreichen, um Risikofaktoren der Thrombogenität im arteriellen System zu identifizieren, sofern es sich nicht gleichzeitig um einen Risikofaktor der Atherosklerose handelt.

Summary

Thrombophilic risk factors of the vascular system are not as well defined as the classic risk factors of atherosclerosis or the thrombophilic risk factors of the venous system. Until now, the assessment is complicated by an inadequate differentiation between (a) proatherosclerotic and prothrombogenic effects (i. e. platelet receptor polymorphisms) and (b) reactive alterations of a haemostatic parameter (i. e. PAI-1, Fibrinogen) as an expression of an acute phase reaction and primary hereditary changes of those risk determinants. Actual data indicate for the majority of the potential risk factors only a mildly increased relative risk for an arterial ischaemic event and are often inconsistent. Anyhow, the impact of potential thrombophilic risk factors for the arterial vascular occlusion is not excluded. A possible reason is, that conventional case-control studies cannot identify risk factors of thrombogenicity in the arterial system unless they are also risk factors of atherosclerosis

Schlüsselwörter

Arterielle Thrombosen - Risikofaktoren - Gerinnung - thrombozytäre Rezeptorpolymorphismen

Keywords

Arterial thrombosis - risk factors - coagulation - platelet receptor polymorphism

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