Stellenwert von Globaltests der Gerinnung zur Erfassung des Rezidivrisikos venöser Thromboembolien

Role of Global Markers of Coagulation for Predicting Recurrent Venous Thromboembolism. Venous thromboembolism is a chronic and potentially fatal disease. Eight years after the acute event, 30 % of patients incur another event of venous thromboembolism, and 5 % of these patients die of pulmonary embolism. Risk of recurrence is determined by the number and potency of risk factors. Determination of recurrence risk is time-consuming and costly, and sometimes not feasible: many patients carry more than one risk factor, the relevance of some factors with regard to risk of recurrence is unknown, and existence of so far unknown risk factors must be considered. Global markers of coagulation can be helpful to stratify patients according to their risk of recurrence. Patients with high thrombin generation have a 3 times higher risk of recurrence than those with lower thrombin generation. Patients with D-Dimer levels < 250 ng/ml have a 60 % lower recurrence rate than those with higher levels. PROLONG is the first interventional trial to investigate efficacy and safety of prolonged secondary thromboprophylaxis among patients stratified by use of a global coagulation marker. Patient with high DDimer, in whom anticoagulation was stopped after six months, had a 5 times higher risk of recurrence than those who received anticoagulation for a longer period of time (10.9 vs 2.0 recurrences/100 patient years). In the prolonged treatment group, one major bleeding complication occurred. On the basis of only one interventional trial, use of the D-Dimer as a single parameter to assess risk of recurrence cannot be recommended. Global coagulation assays can be helpful in situations in which decisions on optimal duration of anticoagulation based on other parameters (clinic, bleeding risk) are difficult. Z Gefasmed 2007; 4 (4): 14–6.