Hämostaseologische Diagnostik und Therapie in der Intensivmedizin

Disorders in hemostasis, leading to hemorrhage or thrombembolic diseases, are of significant importance for intensive care unit (ICU) patients. Possible causes for hemostatic disorders are changes in thrombocyte count or function, changes in plasmatic coagulation or changes in fibrinolysis. Laboratory studies of hemostasis in ICU patients include platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) as well as measurement of fibrinogen, D-dimers and antithrombin. Except for platelet function disorders, for which no suitable screening test is currently available, the vast majority of clinically relevant disorders of hemostasis can be detected by the existing tests. Physicians in ICUs should have knowledge about possible conditions for pathologic test results, as wells as about conditions that interfere with the laboratory studies. Disorders in hemostasis in ICUs are mostly of complex and acquired origin. The differential diagnosis does not only have to consider the pathologic test result but also the underlying disease as well as the trend of the laboratory tests. In recent years, ?point-of-care testing“ has become more and more important in intensive care medicine. This method allows simple and rapid bedside hemostasis analysis. Of clinical importance in intensive care medicine are the following: activated clotting time (ACT) to monitor heparin administration and the so called rotatiol thrombelastography (ROTEG) to analyze clotting formation and stabilization. Platelet concentrates, fresh frozen plasma, blood coagulation factors as well as special pharmacological options are possible tools in the therapy of hemostasic disorders. Therapeutic decisions need to consider clinical aspects as well as the underlying hemostatic disorder and, last but not least, the availability of blood products, factor concentrates and advanced medical treatment.