Hyperfibrinolyse nach Reanimation bei akuter Lungenarterienembolie

Zusammenfassung

Kommt es nach einer Reanimation – z. B. wegen akuter Lungenarterienembolie – im Rahmen eines Post-Cardiac-Arrest-Syndroms (PCAS) zu einer Hyperfibrinolyse, stellt dies eine diagnostische und therapeutische Herausforderung dar. In diesem Fallbericht wird die Pathophysiologie der Koagulopathie bei PCAS beschrieben und der Einsatz antifibrinolytischer Therapie bei Patienten mit thrombotischen Komplikationen wie Lungenarterienembolien diskutiert.

Abstract

Hyperfibrinolysis which can occur in the context of a post-cardiac arrest syndrome (PCAS) after resuscitation – e.g. due to acute pulmonary artery embolism – poses a diagnostic and therapeutic challenge.This case report describes the pathophysiology of coagulopathy in PCAS and discusses the viscoelastometrically monitored use of antifibrinolytic therapy in patients with thrombotic complications such as pulmonary artery embolism.

Schlüsselwörter

disseminierte intravasale Gerinnung - Lungenarterienembolie - Hyperfibrinolyse - Tranexamsäure - Post-Cardiac-Arrest-Syndrom

Keywords

disseminated intravascular coagulation - pulmonary artery embolism - hyperfibrinolysis - tranexamic acid - post-cardiac arrest syndrome

Publikationsverlauf

Artikel online veröffentlicht:
08. Mai 2024

• Literatur

• 1 AWMF. 2015: S2k-Leitlinie Diagnostik und Therapie der Venenthrombose und der Lungenembolie. 2015. Im Internet: http://www.awmf.org/leitlinien/detail/ll/065-002.html; Stand: 22.04.2020
• 2 Alkema L, Chou D, Hogan D. et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 2016; 387: 462-474 DOI: 10.1016/s0140-6736(15)00838-7.
• 3 Kim J, Kim K, Lee JH. et al. Prognostic implication of initial coagulopathy in out-of-hospital cardiac arrest. Resuscitation 2013; 84: 48-53 DOI: 10.1016/j.resuscitation.2012.09.003.
• 4 Negovsky VA. The second step in resuscitation – the treatment of the ‘post-resuscitation disease’. Resuscitation 1972; 1: 1-7 DOI: 10.1016/0300-9572(72)90058-5.
• 5 Wada T, Gando S, Ono Y. et al. Disseminated intravascular coagulation with the fibrinolytic phenotype predicts the outcome of patients with out-of-hospital cardiac arrest. Thromb J 2016; 14: 43 DOI: 10.1186/s12959-016-0116-y.
• 6 Wada T. Coagulofibrinolytic changes in patients with post-cardiac arrest syndrome. Front Med 2017; 4: 156 DOI: 10.3389/fmed.2017.00156.
• 7 Gando S, Wada T. Disseminated intravascular coagulation in cardiac arrest and resuscitation. J Thromb Haemost 2019; 17: 1205-1216 DOI: 10.1111/jth.14480.
• 8 Johansson PI, Stensballe J, Ostrowski SR. Shock induced endotheliopathy (SHINE) in acute critical illness – a unifying pathophysiologic mechanism. Crit Care 2017; 21: 25 DOI: 10.1186/s13054-017-1605-5.
• 9 Bro-Jeppesen J, Johansson PI, Hassager C. et al. Endothelial activation/injury and associations with severity of post-cardiac arrest syndrome and mortality after out-of-hospital cardiac arrest. Resuscitation 2016; 107: 71-79 DOI: 10.1016/j.resuscitation.2016.08.006.
• 10 Johansson PI, Sorensen AM, Perner A. et al. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study. Crit Care 2011; 15: R272 DOI: 10.1186/cc10553.
• 11 Wada T, Gando S, Mizugaki A. et al. Coagulofibrinolytic changes in patients with disseminated intravascular coagulation associated with post-cardiac arrest syndrome – fibrinolytic shutdown and insufficient activation of fibrinolysis lead to organ dysfunction. Thromb Res 2013; 132: e64-e69 DOI: 10.1016/j.thromres.2013.05.010.
• 12 Moore HB, Moore EE, Huebner BR. et al. Fibrinolysis shutdown is associated with a fivefold increase in mortality in trauma patients lacking hypersensitivity to tissue plasminogen activator. J Trauma Acute Care Surg 2017; 83: 1014-1022 DOI: 10.1097/ta.0000000000001718.
• 13 Cotton BA, Harvin JA, Kostousouv V. et al. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg 2012; 73: 365-370 DOI: 10.1097/TA.0b013e31825c1234.
• 14 Myers SP, Kutcher ME, Rosengart MR. et al. Tranexamic acid administration is associated with an increased risk of posttraumatic venous thromboembolism. J Trauma Acute Care Surg 2019; 86: 20-27 DOI: 10.1097/ta.0000000000002061.
• 15 Moore HB, Moore EE, Huebner BR. et al. Tranexamic acid is associated with increased mortality in patients with physiological fibrinolysis. J Surg Res 2017; 220: 438-443 DOI: 10.1016/j.jss.2017.04.028.
• 16 Porter SB, White LJ, Osagiede O. et al. Tranexamic acid administration is not associated with an increase in complications in high-risk patients undergoing primary total knee or total hip arthroplasty: a retrospective case-control study of 38,220 patients. J Arthroplasty 2020; 35: 45-51.e3 DOI: 10.1016/j.arth.2019.08.015.
• 17 CRASH-3 Trial Collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019; 394: 1713-1723 DOI: 10.1016/s0140-6736(19)32233-0.
• 18 Shakur H, Roberts I, Bautista R. et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376: 23-32 DOI: 10.1016/s0140-6736(10)60835-5.
• 19 WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389: 2105-2116 DOI: 10.1016/s0140-6736(17)30638-4.
• 20 Nolan JP, Neumar RW, Adrie C. et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication: a scientific statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke (Part II). Int Emerg Nurs 2010; 18: 8-28 DOI: 10.1016/j.ienj.2009.07.001.
• 21 Cerchiari EL, Safar P, Klein E. et al. Visceral, hematologic and bacteriologic changes and neurologic outcome after cardiac arrest in dogs. The visceral post-resuscitation syndrome. Resuscitation 1993; 25: 119-136 DOI: 10.1016/0300-9572(93)90090-d.