{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T20:03:01Z","timestamp":1649188981030},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"15","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Was ist neu?<\/jats:title><jats:p>\n          H\u00e4ufigkeit thrombotischer Ereignisse\u2002COVID-19 ist deutlich mit einem erh\u00f6hten Thromboserisiko assoziiert. 5\u201311\u200a% der PatientInnen auf Normalstationen und 18\u201328\u200a% der intensivpflichtigen PatientInnen entwickeln eine ven\u00f6se Thromboembolie. Auch das Risiko f\u00fcr arterielle thromboembolische Ereignisse ist erh\u00f6ht: ungef\u00e4hr 3\u200a% der COVID-19-PatientInnen auf einer Intensivstation erleiden einen Herzinfarkt, Schlaganfall oder eine systemische Embolie. Zus\u00e4tzlich zum prothrombotischen Zustandsbild ist auch das Blutungsrisiko erh\u00f6ht (3,9\u200a% bei hospitalisierten PatientInnen). F\u00fcr ambulant betreute oder bereits wieder entlassene PatientInnen d\u00fcrfte das Thromboserisiko gering sein.<\/jats:p><jats:p>\n          Pathomechanismus: Koagulopathie\u2002Bei COVID-19 besteht ein prothrombotisches Zustandsbild, hervorgerufen durch ein Zusammenspiel aus Infektionserreger, Inflammation und dem Gerinnungssystem. Die sich potenzierenden Effekte verursachen eine Endothelaktivierung, die Aussch\u00fcttung proinflammatorischer Zytokine und eine Kettenreaktion im Gerinnungssystem. Laborchemisch imponieren bei der COVID-19-assoziierten Koagulopathie ein stark erh\u00f6htes D-Dimer, hohes Fibrinogen, eine verl\u00e4ngerte Prothrombinzeit sowie eine verminderte Thrombozytenanzahl. Das \u00fcberproportional hohe Auftreten von Lungenembolien l\u00e4sst eine teilweise pulmonale Thrombenentstehung vermuten, welche auf Basis der entkoppelten Inflammation entsteht. Die Aktivierung des Gerinnungssystems durch COVID-19 kann sich auch prognostisch zunutze gemacht werden, um Morbidit\u00e4t und Letalit\u00e4t anhand von Gerinnungsparametern abzusch\u00e4tzen.<\/jats:p><jats:p>\n          Therapie und Thromboseprophylaxe\u2002Aufgrund des hohen thrombotischen Risikos ist eine prophylaktische Antikoagulation, bevorzugt mit niedermolekularem Heparin, bei allen hospitalisierten PatientInnen indiziert. Lediglich \u00fcber die Dosierung herrscht Unklarheit. Neue randomisiert-kontrollierte Studien zeigen erste Signale: eine therapeutische oder intermedi\u00e4re Antikoagulation scheint keinen Vorteil gegen\u00fcber einer Standardprophylaxe f\u00fcr intensivpflichtige PatientInnen zu bringen. Es ist jedoch m\u00f6glich, dass eine therapeutische Dosierung, eingesetzt auf Normalstationen bei PatientInnen mit (noch) moderatem Verlauf, zu einem besseren Outcome f\u00fchrt. F\u00fcr ambulant betreute oder bereits entlassene PatientInnen ist die Evidenz nach wie vor gering. In beiden F\u00e4llen ist keine routinem\u00e4\u00dfige Antikoagulation empfohlen. Bei niedrigem Blutungsrisiko kann jedoch eine Thromboseprophylaxe erwogen werden.<\/jats:p>","DOI":"10.1055\/a-1497-9028","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T22:33:09Z","timestamp":1628029989000},"page":"944-949","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19-assoziierte Koagulopathie"],"prefix":"10.1055","volume":"146","author":[{"given":"Stephan","family":"Nopp","sequence":"additional","affiliation":[{"name":"Klinische Abteilung f\u00fcr H\u00e4matologie und H\u00e4mostaseologie, Universit\u00e4tsklinik f\u00fcr Innere Medizin I, Medizinische Universit\u00e4t Wien, \u00d6sterreich"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cihan","family":"Ay","sequence":"additional","affiliation":[{"name":"Klinische Abteilung f\u00fcr H\u00e4matologie und H\u00e4mostaseologie, Universit\u00e4tsklinik f\u00fcr Innere Medizin I, Medizinische Universit\u00e4t Wien, 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