@phdthesis{Rabie2005,
  author    = {Rabie, Tamer},
  title     = {Cellular regulation of platelet glycoprotein VI : in vivo and in vitro studies in mice},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-14267},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2005},
  abstract  = {Platelet interaction with the subendothelium is essential to limit blood loss after tissue injury. However, upon rupture of atherosclerotic plaques, this interaction may result in blood vessel occlusion leading to life threatening diseases such as myocardial infarction or stroke. Among the subendothelial matrix proteins, collagen is considered to be the most thrombogenic component as it directly activates platelets. Platelets interact with collagen, either indirectly through glycoprotein (GP) Ib-V-IX receptor complex, or directly through the major collagen receptor on the platelet surface, GPVI. The work presented here focused on studying the cellular regulation of GPVI. In addition, a possible role for GPVI in thrombus formation induced by atherosclerotic plaque material was investigated and it was found that GPVI plays an important role in this process. Using a recently published mitochondrial injury model, it was found that GPVI contains a cleavage site for a platelet-expressed metalloproteinase. Further studies showed that platelet activation by CRP, or thrombin induced down-regulation of GPIb\&\#61537;, but not GPVI. In parallel, cellular regulation of GPV was studied and it was found that GPV is cleaved in vitro by the metalloproteinase ADAM17. In previous studies it was shown that injection of mice with the anti-GPVI mAb, JAQ1, induces GPVI down-regulation, which is associated with a strong, but transient, thrombocytopenia. Using new anti-GPVI mAbs, which bind different epitopes on the receptor, it is shown in this study that GPVI down-regulation occurs in an epitope-independent manner. Further experiments showed that antibody treatment induces a transient, but significant increase in bleeding time. Using different genetically modified mice, it is shown that, upon antibody injection, GPVI is both, shed from the platelet surface and internalized into the platelet. Signaling through the immunoreceptor tyrosine-based activation motif (ITAM) of the FcR\&\#61543; chain is essential for both processes, while LAT and PLC\&\#61543;2 are essential for the shedding process only. Antibody-induced increase in bleeding time and thrombocytopenia were absent in LAT deficient mice, showing that it is possible to uncouple the associated side effects from the down-regulation process. As antibody-induced GPVI internalization still occurs in LAT and PLC\&\#61543;2 deficient mice, this suggests a novel signaling pathway downstream of GPVI that has not been described so far.},
  subject      = {Maus},
  language  = {en}
}
@phdthesis{Heidenreich2018,
  author    = {Heidenreich, Julius Frederik},
  title     = {Characterization of the widely used Rac1-inhibitors NSC23766 and EHT1864 in mouse platelets},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165453},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2018},
  abstract  = {Platelet activation and aggregation at sites of vascular injury is critical to prevent excessive blood loss, but may also lead to life-threatening ischemic diseases, such as myocardial infarction and stroke. Extracellular agonists induce platelet activation by stimulation of platelet membrane receptors. Signal transduction results in reorganization of the cytoskeleton, shape change, platelet adhesion and aggregation, cumulating in thrombus formation. Several Rho GTPases, including Rac1, Cdc42 and RhoA, are essential mediators of subsequent intracellular transduction of ITAM- and GPCR-signaling. Therefore, inhibition or knockout can result in severely defective platelet signaling. Mice with platelet specific Rac1-deficiency are protected from arterial thrombosis. This benefit highlights further investigation of Rac1-specific functions and its potential as a new pharmacological target for prevention of cardiovascular diseases. Two newly developed synthetic compounds, NSC23766 and EHT1864, were proposed to provide highly specific inhibition of Rac1 activity, but both drugs have never been tested in Rac1-deficient cell systems to rule out potential Rac1-independent effects. This study revealed significant off-target effects of NSC23766 and EHT1864 that occurred in a dose-dependent fashion in both wild-type and Rac1-deficient platelets. Both inhibitors individually affected resting platelets after treatment, either by altering membrane protein expression (NSC23766) or by a marked decrease of platelet viability (EHT1864). Platelet apoptosis could be confirmed by enhanced levels of phosphatidylserine exposure and decreased mitochondrial membrane potential. Phosphorylation studies of the major effector proteins of Rac1 revealed that NSC23766 and EHT1864 abolish PAK1/PAK2 activation independently of Rac1 in wild-type and knockout platelets, which may contribute to the observed off-target effects. Additionally, this study demonstrated the involvement of Rac1 in G protein-coupled receptor-mediated platelet activation and GPIb-induced signaling. Furthermore, the data revealed that Rac1 is dispensable in the process of integrin IIb 3-mediated clot retraction. This study unveiled that new pharmacological approaches in antithrombotic therapy with Rac1 as molecular target have to be designed carefully in order to obtain high specificity and minimize potential off-target effects.},
  subject      = {Thrombozyt},
  language  = {en}
}
@phdthesis{Reibetanz2006,
  author    = {Reibetanz, Konrad Joachim},
  title     = {Das prokoagulatorische Potential hoher Faktor XI-Spiegel bei der ven{\"o}sen Thromboembolie},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-18634},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2006},
  abstract  = {Hoher Faktor XI stellt einen Risikofaktor der ven{\"o}sen Thrombose dar, {\"u}ber welchen Mechanismus hohe Faktor XI-Spiegel dabei thrombogen wirken ist noch weitestgehend unklar. Denkbar w{\"a}re eine Faktor XI-abh{\"a}ngige gesteigerte Thrombingenerierung. Andererseits ist eine gesteigerte Thrombingenerierung ein Merkmal von Patienten mit einer Faktor V Leiden-Mutation. Allerdings zeigen bei weitem nicht alle dieser Patienten eine Hyperkoagulabilit{\"a}t und nur ein Bruchteil davon wird jemals durch Thrombosen auff{\"a}llig. Entsprechend den Vorstellungen einer multifaktoriellen Thrombogenese war es daher unsere Vermutung, dass erh{\"o}hte Faktor XI-Spiegel bei bereits bestehender thrombophiler Gerinnungsst{\"o}rung die Thrombinbildung zus{\"a}tzlich triggern k{\"o}nnten und so das Risiko der Thromboseentstehung bei diesen Patienten weiter steigern. Zwei Patientengruppen nach ven{\"o}ser Thrombose wurden untersucht: 76 Faktor V Leiden-Tr{\"a}ger und 116 nicht-thrombophile Thrombosepatienten, alters- und geschlechtsgematchte Blutspender dienten als Kontrollen. Faktor XI, TAFIa/ai und F1+2-Spiegel wurden mittels ELISA, die Faktor V Leiden-Mutation, der Prothrombin-Polymorphismus, Faktor VIII, AT, PC und PS, sowie Antiphospholipid-Antik{\"o}rper mittels Routine-Assays bestimmt. Mit unseren Ergebnissen konnten wir zeigen, dass ein erh{\"o}hter Faktor XI-Spiegel keinen eigenst{\"a}ndigen Risikofaktor f{\"u}r die ven{\"o}se Thromboembolie darstellt, sondern seine thrombogene Wirkung erst im Zusammenwirken mit einer zugrunde liegenden Faktor V Leiden-Mutation erh{\"a}lt. Bei diesen Patienten scheint das mit hohen Faktor XI-Spiegeln assoziierte Thromboserisiko in einer beschleunigten Thrombinbildung und weniger in einer Faktor XI-abh{\"a}ngigen Fibrinpolysehemmung begr{\"u}ndet zu sein. Wir konnten daher Faktor XI als einen von der Faktor V Leiden-Mutation abh{\"a}ngigen, in seiner Auspr{\"a}gung moderaten Risikofaktor der Thrombose identifizieren. Dies steht in Einklang mit unseren Ergebnissen: Faktor XI nimmt bei diesen Patienten Einfluss auf die Thrombingenerierung, dar{\"u}ber hinaus jedoch nicht auf das fibrinolytische System.},
  language  = {de}
}
@phdthesis{Thielmann2014,
  author    = {Thielmann, Ina},
  title     = {Function and regulation of phospholipase D in blood platelets: in vitro and in vivo studies in mice},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-99179},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2014},
  abstract  = {Summary Platelet activation and aggregation are crucial for primary hemostasis but can also result in occlusive thrombus formation. Agonist induced platelet activation involves different signaling pathways leading to the activation of phospholipases (PL) which produce second messengers. While the role of PLCs in platelet activation is well established, less is known about the relevance of PLDs. In the current study, the function and regulation of PLD in platelets was investigated using genetic and pharmacological approaches. In the first part of this thesis, adhesion, activation and aggregation of platelets from mice lacking PLD2 or both PLD1 and PLD2 were analyzed in vitro and in vivo. While the absence of PLD2 resulted in slightly reduced PLD activity in platelets, it had no detectable effect on the platelet function in vitro and in vivo. However, the combined deficiency of both PLD isoforms resulted in defective alpha-granule release and protection in a model of ferric chloride induced arteriolar thrombosis, effects that were not observed in mice lacking only one PLD isoform. These results revealed, for the first time, redundant roles of PLD1 and PLD2 in platelet alpha-granule secretion and indicate that this may be relevant for pathological thrombus formation. Thus, PLD might represent a promising target for antithrombotic therapy. Thus, this hypothesis was tested more directly in the second part of this thesis. The effects of pharmacological inhibition of PLD activity on hemostasis, thrombosis and thrombo-inflammatory brain infarction in mice were assessed. Treatment of platelets with the reversible, small molecule PLD inhibitor 5-Fluoro-2-indolyl des-chlorohalopemide (FIPI) led to a specific blockade of PLD activity that was associated with reduced -granule release and integrin activation. Mice that received FIPI at a dose of 3 mg/kg displayed reduced occlusive thrombus formation upon chemical injury of carotid arteries or mesenterial arterioles. Similarly, FIPI-treated mice had smaller infarct sizes and significantly better motor and neurological function 24 hours after transient middle cerebral artery occlusion. This protective effect was not associated with major intracerebral hemorrhage or prolonged tail bleeding times. Thus, pharmacological PLD inhibition might represent a safe therapeutic strategy to prevent arterial thrombosis or ischemic stroke. After revealing a central role for PLD in thrombo-inflammation, the regulation of PLD activity in platelets was analyzed in the last part of the thesis. Up to date, most studies made use of inhibitors potentially exerting off-target effects and consequently PLD regulation is discussed controversially. Therefore, PLD activity in mice genetically lacking potential modulators of PLD activity was determined to address these controversies. These studies revealed that PLD is tightly regulated during initial platelet activation. While integrin outside-in signaling and Gi signaling was dispensable for PLD activation, it was found that PLC dependent pathways were relevant for the regulation of PLD enzyme activity.},
  subject      = {Phospholipase D},
  language  = {en}
}
@phdthesis{Schwab2012,
  author    = {Schwab, Marco},
  title     = {Genetische und erworbene thrombophile Gerinnungsst{\"o}rungen als Quelle chronischer Schmerzsyndrome},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-77457},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2012},
  abstract  = {Anhand einer umfassenden Falldarstellung einer jungen Patientin mit einem lebensbedrohlichen Gesichtsschmerzsyndrom, das nach septischer Thrombose der periorbitalen ven{\"o}sen und arteriellen Gef{\"a}ße aufgetreten war, wurde die Bedeutung einer medikament{\"o}sen Antikoagulation f{\"u}r die erfolgreiche Schmerztherapie herausgearbeitet. An diesem Fallbeispiel konnte aber auch gezeigt werden, dass keine sicheren Parameter f{\"u}r die Indikation einer solchen Gerinnungstherapie vorlagen. Die Bedeutung dieses Falls lag unzweifelhaft in der Erkenntnis, dass in einer anhaltenden Aktivierung des Kontaktsystems der Gerinnung ein bislang untersch{\"a}tztes Potential f{\"u}r die Entstehung und Unterhaltung ungekl{\"a}rter Schmerzen liegen k{\"o}nnte und nicht zuletzt auch daran, dass sich diese {\"a}tiologische Komponente in der Komplexit{\"a}t der Erkrankung diagnostisch nicht eindeutig sichern ließ. Mit der Translokation von LPS aus der intestinalen Mukosa in endothelial vorgesch{\"a}digte Gef{\"a}ßabschnitte wurde eine Hypothese vorgetragen, die neben einer schwer detektierbaren inflammatorischen Komponente auch das prokoagulatorische Potential der Schmerzentstehung erkl{\"a}ren k{\"o}nnte. Die prokoagulatorische Komponente dieses hypothetischen Entstehungs-mechanismus chronischer Schmerzen m{\"u}sste, so die Arbeitshypothese, umso dominanter sein, wenn prokoagulatorisch wirksame genetische Faktoren bei den Patienten hinzukommen. Unter der Annahme, dass eine solche zus{\"a}tzliche Diathese nicht nur eine Schrittmacherfunktion haben, sondern auch einen diagnostischen Beitrag liefern k{\"o}nnte, wurde dieses diagnostische Pilotprojekt mit der empirisch begr{\"u}ndeten Heparintherapie von 97 Schmerzpatienten verbunden. Alle Pa-tienten wurden mit dem niedermolekularen Heparin Enoxaparin behandelt und nach zehn Behandlungstagen in vier verschiedene Respondergruppen (Gruppe 1 bis 4) eingeteilt. Diese Gruppen wurden auf f{\"u}nf prothrombotische Parameter untersucht. Dazu wurden die Allelpr{\"a}valenzen des Plasminogen Aktivator Inhibitor-(PAI-1 4G/5G) Polymorphismus, der Faktor V-Leiden-Mutation, der Prothrombin (G20210A) Genmutation sowie die Pr{\"a}valenzen der Hyperfibrinogen{\"a}mie und des Protein S-Mangels ermittelt. Mit Hilfe des exakten Fisher Tests wurden jeweils die Allelpr{\"a}valenzen und Parameter sowohl der Respondergruppen 1 bis 3 mit einem Kollektiv der Allgemeinbev{\"o}lkerung als auch mit dem Kollektiv der Non-Responder (Gruppe 4) verglichen. Die Pr{\"a}valenz des Allels A der Faktor V-Leiden-Mutation G1691A war im Enoxaparin-Kollektiv bei den Respondern der Gruppen 1 bis 3 im Vergleich zur Allgemeinbev{\"o}lkerung und zur Non-Respondergruppe (Gruppe 4) signifikant erh{\"o}ht. Die Allelpr{\"a}valenzen und Parameter der {\"u}brigen prokoagulatorischen Faktoren unterschieden sich von denen der Kontrollgruppen nicht. Anhand des Kallikrein-Kinin-Systems als m{\"o}glichem Effektor des H{\"a}mosta-sesystems konnten Hinweise auf die kausale Wirksamkeit des nieder-molekularen Heparins Enoxaparin bei der Behandlung chronischer Schmerzen gegeben werden.},
  subject      = {chronisches Schmerzsyndrom},
  language  = {de}
}
@phdthesis{Brown2023,
  author    = {Brown, Helena Charlotte},
  title     = {Investigating the role of the platelet receptor C-type lectin-like receptor 2 in models of thrombosis},
  doi       = {10.25972/OPUS-29310},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-293108},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Platelets have a key physiological role in haemostasis however, inappropriate thrombus formation can lead to cardiovascular diseases such as myocardial infarction or stroke. Although, such diseases are common worldwide there are comparatively few anti-platelet drugs, and these are associated with an increased risk of bleeding. Platelets also have roles in thrombo-inflammation, immuno-thrombosis and cancer, in part via C-type lectin-like receptor 2 (CLEC-2) and its ligand podoplanin. Although CLEC-2 contributes to these diseases in mice, as well as to thrombus stability, it is unclear whether CLEC-2 has similar roles in humans, particularly as human CLEC-2 (hCLEC-2) cannot be investigated experimentally in vivo. To investigate hCLEC-2 in vivo, we generated a humanised CLEC-2 mouse (hCLEC-2KI) model, as well as a novel monoclonal antibody, HEL1, that binds to a different site than an existing antibody, AYP1. Using these antibodies, we have provided proof of principle for the use of hCLEC-2KI mice to test potential therapeutics targeting hCLEC-2, and shown for the first time that hCLEC-2 can be immunodepleted, with little effect on haemostasis. However, our results have also suggested that there are species differences in the role of CLEC-2 in arterial thrombosis. We further confirmed this using human blood where blocking CLEC-2 ligand binding had no effect on thrombosis, whereas we confirmed a minor role for mouse CLEC-2 in thrombus stability. We also investigated the effect of blocking CLEC-2 signalling using the Bruton's tyrosine kinase inhibitor PRN473 on CLEC-2 mediated immuno-thrombosis in a Salmonella typhimurium infection model. However, no effect on thrombosis was observed suggesting that CLEC-2 signalling is not involved. Overall, our results suggest that there may be differences in the role of human and mouse CLEC-2, at least in arterial thrombosis, which could limit the potential of CLEC-2 as an anti-thrombotic target. However, it appears that the interaction between CLEC-2 and podoplanin is conserved and therefore CLEC-2 could still be a therapeutic target in immuno-thrombosis, thrombo-inflammation and cancer. Furthermore, any potential human specific therapeutics could be investigated in vivo using hCLEC-2KI mice.},
  subject      = {Thrombozyt},
  language  = {en}
}
@phdthesis{Schmid2017,
  author    = {Schmid, Sophie Petra},
  title     = {katheterassoziierte Thrombosen bei p{\"a}diatrischen Patienten mit maligner Erkrankung - eine retrospektive Studie {\"u}ber f{\"u}nf Jahre},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-149395},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2017},
  abstract  = {Background: Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins—e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring—can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage. Methods: Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation. Results: Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20\%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis. Conclusions: We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool tom minimize CVC-associated complications.},
  subject      = {zentral ven{\"o}ser Katheter},
  language  = {de}
}
@phdthesis{Popp2018,
  author    = {Popp, Michael},
  title     = {Mechanisms of platelet activation and receptor regulation in genetically modified mice},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-135494},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2018},
  abstract  = {This work summarizes the results of studies on several major aspects of platelet activation and platelet receptor regulation. Therefore, this thesis is divided into four parts. Platelet activation and aggregation at sites of vascular injury is critical to prevent excessive blood loss, but may also lead to life-threatening ischemic disease states, such as myocardial infarction and stroke. Agonist-induced elevation in cytosolic Ca2+ concentrations is essential for platelet activation in hemostasis and thrombosis. The principal route of Ca2+ influx in platelets is store-operated calcium entry (SOCE). The calcium sensor molecule stromal interaction molecule 1 (STIM1) regulates SOCE by activating the membrane calcium channel protein Orai1, but the exact mechanisms of this interaction are not fully understood. Using affinity chromatography to screen for STIM1 interacting proteins in platelets, bridging integrator 2 (BIN2), an adapter protein belonging to the family of BAR proteins that is mainly expressed in the hematopoietic system, was identified. Newly generated BIN2 KO mice were viable and fertile but their platelets displayed markedly impaired SOCE in response to thapsigargin (TG) as well as agonists acting on immunoreceptor tyrosine-based activation motif (ITAM) or G protein-coupled receptors. This SOCE defect resulted in impaired (hem)ITAM induced platelet activation, aggregate formation under flow and procoagulant activity. As a consequence, mice lacking BIN2 in platelets were protected from occlusive arterial thrombus formation and thrombo-inflammatory cerebral infarct progression in a model of experimental stroke. These results identify BIN2 as a critical regulator of platelet SOCE in thrombosis and thrombo-inflammatory disease. Integrin αIIbβ3 plays a central role in the adhesion and aggregation of platelets. Integrin activation requires the transmission of a signal from the small cytoplasmic tails of the α or β subunit to the large extracellular domains resulting in conformational changes of the extracellular domains to enable ligand binding. It was hypothesized that Hic-5 is a novel regulator of integrin αIIbβ3 activation in mice. As demonstrated in the second part of this thesis, lack of Hic-5 had no detectable effect on platelet integrin activation and function in vitro and in vivo under all tested conditions. These results indicate that Hic-5 is dispensable for integrin αIIbβ3 activation and consequently for arterial thrombosis and hemostasis in mice. The Rho GTPase family members RhoA and Rac1 play major roles in platelet activation at sites of vascular injury. Little is known about possible redundant functions of these Rho GTPases in regulating platelet function. To investigate functional redundancies of RhoA and Rac1 in platelet production and function, mice with MK- and platelet-specific double- deficiencies in RhoA and Rac1 were generated. RhoA/Rac1 double-deficiency phenocopied the respective single knockouts without any additional effects in the double-knockout animals, demonstrating for the first time a functional non-redundancy of RhoA and Rac1 in platelet function. Antibodies against platelet glycoproteins (GP) trigger platelet destruction in immune thrombocytopenia (ITP) by binding to Fcγ receptors (FcγRs) on immune cells. However, antibodies against the platelet collagen receptor GPVI exert powerful anti-thrombotic action in vivo by inducing ectodomain shedding of the receptor associated with a transient thrombocytopenia. As shown in the final part of this thesis, blockade or deficiency of the inhibitory FcγRIIB abolished sequestration of anti-GPVI opsonized platelets in the hepatic vasculature and GPVI shedding. This process was mediated by liver sinusoidal endothelial cells (LSEC), the major FcγRIIB expressing cell type in the body. Furthermore, LSEC FcγRIIB mediated hepatic platelet sequestration and contributed to thrombocytopenia in mice treated with antibodies against αIIbβ3, the major target antigen in human ITP. These results reveal a novel and unexpected function of hepatic FcγRIIB in the processing of antibody-opsonized platelets.},
  subject      = {H{\"a}mostase},
  language  = {en}
}
@phdthesis{Morowski2014,
  author    = {Morowski, Martina},
  title     = {Relevance of platelet count and ITAM-signalling pathway in murine models of haemostasis, thrombosis and thrombo-inflammation},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-99193},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2014},
  abstract  = {Platelets are important players in haemostasis and their activation is essential to limit post-traumatic blood loss upon vessel injury. On the other hand, pathological platelet activation may lead to thrombosis resulting in myocardial infarction and stroke. Platelet activation and subsequent thrombus formation are, therefore, tightly regulated and require a well-defined interplay of platelet surface receptors, intracellular signalling molecules, cytoskeletal rearrangements and the activation of the coagulation cascade. In vivo thrombosis and haemostasis models mimic thrombus formation at sites of vascular lesions and are frequently used to assess thrombotic and haemostatic functions of platelets. In this dissertation, different in vivo models were used in mice to address the question at what level a reduced platelet count (PC) compromises stable thrombus formation. To study this, mice were rendered thrombocytopenic by low-dose anti-GPIbα antibody treatment and subjected to a tail bleeding time assay as well as to four different in vivo thrombosis models. Haemostasis and occlusive thrombus formation in small vessels were only mildly affected even at severe reductions of the PC. In contrast, occlusive thrombus formation in larger arteries required higher PCs demonstrating that considerable differences in the sensitivity for PC reductions exist between these models. In a second part of this study, mice were rendered thrombocytopenic by injection of high-dose anti-GPIbα antibody which led to the complete loss of all platelets from the circulation for several days. During recovery from thrombocytopenia, the newly generated platelet population was characterised and revealed a defect in immunoreceptor tyrosine-based activation motif (ITAM)-signalling. This defect translated into impaired arterial thrombus formation. To further investigate ITAM-signalling in vivo, genetically modified mice were analysed which display a positive or negative regulation of platelet ITAM-signalling in vitro. Whereas mice lacking the adapter Grb2 in platelets showed a delayed thrombus formation in vivo after acetylsalicylic acid treatment, Clp36ΔLIM bone marrow chimeric mice and SLAP/SLAP2-deficient mice displayed pro-thrombotic properties in vivo. Finally, mice lacking the adapter protein EFhd2 were analysed in vitro and in vivo. However, EFhd2-deficient platelets showed only a minor increase in the procoagulant activity compared to control.},
  subject      = {Thrombozyt},
  language  = {en}
}
@phdthesis{Pozgajova2005,
  author    = {Pozgajova, Miroslava},
  title     = {Studies on formation and stabilization of pathological thrombi in vivo},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-16784},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2005},
  abstract  = {Platelet activation and adhesion resulting in thrombus growth is essential for normal hemostasis, but can lead to irreversible, life-threatening vessel occlusion. In the current study, the contribution of platelet integrins, activation receptors and the contact system of blood coagulation in such pathological conditions was investigated in mice.},
  subject      = {Thrombose},
  language  = {en}
}
@phdthesis{Voegtle2014,
  author    = {V{\"o}gtle, Timo},
  title     = {Studies on receptor signaling and regulation in platelets and T cells from genetically modified mice},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-97114},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2014},
  abstract  = {Receptors with tyrosine-based signaling motifs control essential functions of hematopoietic cells, including lymphocytes and platelets. Downstream of the platelet receptor glycoprotein (GP) VI and the T cell receptor (TCR) the immunoreceptor tyrosine-based activation motif (ITAM) initiates a signaling cascade that involves kinases, adapter and effector proteins and finally leads to cellular activation. This thesis summarizes the results of three studies investigating different aspects of receptor signaling and regulation in platelets and T cells. In the first part, the impact of constitutive Ca2+ influx on TCR signaling and T cell physiology was investigated using a transgenic mouse line with a mutation in the Ca2+ sensor stromal interaction molecule 1 (STIM1). The elevated cytoplasmic Ca2+ level resulted in an altered phosphorylation pattern of the key enzyme phospholipase (PL) Cγ1 in response to TCR stimulation, but without affecting its enzymatic activity. Withdrawal of extracellular Ca2+ or inhibition of the phosphatase calcineurin restored the normal phosphorylation pattern. In addition, there was a decrease in the release of Th2-type cytokines interleukin 4, 5 and 13 upon stimulation in vitro. The second part of the thesis deals with the role of the adapter protein growth factor receptor-bound protein 2 (Grb2) in platelets using a megakaryocyte/platelet-specific knockout mouse line. Loss of Grb2 severely impaired signaling of GPVI and C-type lectin-like receptor 2 (CLEC-2), a related hemITAM receptor. This was attributed to defective stabilization of the linker for activation of T cells (LAT) signalosome and resulted in reduced adhesion, aggregation, Ca2+ mobilization and procoagulant activity downstream of (hem)ITAM-coupled receptors in vitro. In contrast, the signaling pathways of G protein-coupled receptors (GPCRs) and the integrin αIIbβ3, which do not utilize the LAT signalosome, were unaffected. In vivo, the defective (hem)ITAM signaling caused prolonged bleeding times, however, thrombus formation was only affected under conditions where GPCR signaling was impaired (upon acetylsalicylic acid treatment). These results establish Grb2 as an important adapter protein in the propagation of GPVI- and CLEC-2-induced signals. Finally, the proteolytic regulation of the immunoreceptor tyrosine-based switch motif (ITSM)-bearing receptor CD84 in platelets was investigated. This study demonstrated that in mice CD84 is cleaved by two distinct and independent proteolytic mechanisms upon platelet activation: shedding of the extracellular part, which is exclusively mediated by a disintegrin and metalloproteinase (ADAM) 10 and cleavage of the intracellular C-terminus by the protease calpain. Finally, the analysis of soluble CD84 levels in the plasma of transgenic mice revealed that shedding of CD84 by ADAM10 occurs constitutively in vivo.},
  subject      = {Thrombozyt},
  language  = {en}
}
@phdthesis{Heydenreich2013,
  author    = {Heydenreich, Nadine},
  title     = {Studies on the contact-kinin system and macrophage activation in experimental focal cerebral ischemia},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-94534},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2013},
  abstract  = {Traditionally, ischemic stroke has been regarded as the mere consequence of cessation of cerebral blood flow, e.g. due to the thromboembolic occlusion of a major brain supplying vessel. However, the simple restoration of blood flow via thrombolysis and/or mechanical recanalization alone often does not guarantee a good functional outcome. It appears that secondary detrimental processes are triggered by hypoxia and reoxygenation, which are referred to as ischemia/reperfusion (I/R) injury. During recent years it became evident that, beside thrombosis inflammation and edema formation are key players in the pathophysiology of cerebral ischemia. The contact-kinin system represents an interface between thrombotic, inflammatory and edematous circuits. It connects the intrinsic coagulation pathway with the plasma kallikrein-kinin system (KKS) via coagulation factor FXII. The serine protease inhibitor C1-inhibitor (C1-INH) has a wide spectrum of inhibitory activities and counteracts activation of the contact-kinin system at multiple levels. The first part of the thesis aimed to multimodally interfere with infarct development by C1-INH and to analyze modes of actions of human plasma derived C1-INH Berinert® P in a murine model of focal cerebral ischemia. It was shown that C57BL/6 mice following early application of 15.0 units (U) C1-INH, but not 7.5 U developed reduced brain infarctions by ~60\% and less neurological deficits in the model of transient occlusion of the middle cerebral artery (tMCAO). This protective effect was preserved at more advanced stages of infarction (day 7), without increasing the risk of intracerebral bleeding or affecting normal hemostasis. Less neurological deficits could also be observed with delayed C1-INH treatment, whereas no improvement was achieved in the model of permanent MCAO (pMCAO). Blood-brain-barrier (BBB) damage, inflammation and thrombosis were significantly improved following 15.0 U C1-INH application early after onset of ischemia. Based on its strong antiedematous, antiinflammatory and antithrombotic properties C1-INH constitutes a multifaceted therapeutic compound that protects from ischemic neurodegeneration in 'clinically meaningful' settings. The second part of the thesis addresses the still elusive functional role of macrophages in the early phase of stroke, especially the role of the macrophage-specific adhesion molecule sialoadhesin (Sn). For the first time, sialoadhesin null (Sn-/-) mice, homozygous deficient for Sn on macrophages were subjected to tMCAO to assess the clinical outcome. Neurological and motor function was significantly improved in Sn-/- mice on day 1 after ischemic stroke compared with wildtype (Sn+/+) animals. These clinical improvements were clearly detectable even on day 3 following tMCAO. Infarctions on day 1 were roughly the same size as in Sn+/+ mice and did not grow until day 3. No intracerebral bleeding could be detected at any time point of data acquisition. Twenty four hours after ischemia a strong induction of Sn was detectable in Sn+/+ mice, which was previously observed only on perivascular macrophages in the normal brain. Deletion of Sn on macrophages resulted in less disturbance of the BBB and a reduced number of CD11b+ (specific marker for macrophages/microglia) cells, which, however, was not associated with altered expression levels of inflammatory cytokines. To further analyze the function of macrophages following stroke this thesis took advantage of LysM-Cre+/-/IKK2-/- mice bearing a nuclear factor (NF)-ϰB activation defect in the myeloid lineage, including macrophages. Consequently, macrophages were not able to synthesize inflammatory cytokines under the control of NF-ϰB. Surprisingly, infarct sizes and neurological deficits upon tMCAO were roughly the same in conditional knockout mice and respective wildtype littermates. These findings provide evidence that macrophages do not contribute to tissue damage and neurological deficits, at least, not by release of inflammatory cytokines in the early phase of cerebral ischemia. In contrast, Sn which is initially expressed on perivascular macrophages and upregulated on macrophages/microglia within the parenchyma following stroke, influenced functional outcome.},
  subject      = {Blut-Hirn-Schranke},
  language  = {en}
}
@phdthesis{vanEeuwijk2018,
  author    = {van Eeuwijk, Judith Martina Maria},
  title     = {Studies on thrombopoiesis and spleen tyrosine kinase-mediated signaling in platelets},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-142933},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2018},
  abstract  = {In mammals, anucleate blood platelets are constantly produced by their giant bone marrow (BM) progenitors, the megakaryocytes (MKs), which originate from hematopoietic stem cells. Megakaryopoiesis and thrombopoiesis have been studied intensively, but the exact mechanisms that control platelet generation from MKs remain poorly understood. Using multiphoton intravital microscopy (MP-IVM), thrombopoiesis and proplatelet formation were analyzed in the murine BM in real-time and in vivo, identifying an important role for several proteins, including Profilin1, TRPM7 and RhoA in thrombopoiesis. Currently, it is thought that blood cell precursors, such as MKs, migrate from the endosteal niche towards the vascular niche during maturation. In contrast to this paradigm, it was shown that MKs are homogeneously distributed within the dense BM blood vessel network, leaving no space for vessel-distant niches. By combining results from in vivo MP-IVM, in situ light-sheet fluorescence microscopy (LSFM) of the intact BM as well as computational simulations, surprisingly slow MK migration, limited intervascular space and a vessel-biased MK pool were revealed, contradicting the current concept of directed MK migration during thrombopoiesis. Platelets play an essential role in hemostasis and thrombosis, but also in the pathogenesis of ischemic stroke. Ischemic stroke, which is mainly caused by thromboembolic occlusion of brain arteries, is among the leading causes of death and disability worldwide with limited treatment options. The platelet collagen receptor glycoprotein (GP) VI is a key player in arterial thrombosis and a critical determinant of stroke outcome, making its signaling pathway an attractive target for pharmacological intervention. The spleen tyrosine kinase (Syk) is an essential signaling mediator downstream of GPVI, but also of other platelet and immune cell receptors. In this thesis, it was demonstrated that mice lacking Syk specifically in platelets are protected from arterial thrombus formation and ischemic stroke, but display unaltered hemostasis. Furthermore, it was shown that mice treated with the novel, selective and orally bioavailable Syk inhibitor BI1002494 were protected in a model of arterial thrombosis and had smaller infarct sizes and a significantly better neurological outcome 24 h after transient middle cerebral artery occlusion (tMCAO), also when BI1002494 was administered therapeutically, i.e. after ischemia. These results provide direct evidence that pharmacological Syk inhibition might become a safe therapeutic strategy. The T cell receptor  chain-associated protein kinase of 70 kDA (Zap-70) is also a spleen tyrosine kinase family member, but has a lower intrinsic activity compared to Syk and is expressed in T cells and natural killer (NK) cells, but not in platelets. Unexpectedly, arterial thrombus formation in vivo can occur independently of Syk kinase function as revealed by studies in Sykki mice, which express Zap-70 under the control of intrinsic Syk promoter elements.},
  subject      = {Thrombose},
  language  = {en}
}
@phdthesis{May2011,
  author    = {May, Frauke},
  title     = {The role of the (hem)ITAM-coupled receptors C-type lectin-like receptor 2 (CLEC-2) and Glycoprotein (GP) VI for platelet function: in vitro and in vivo studies in mice},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-65383},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2011},
  abstract  = {Die Thrombozytenaktivierung und -adh{\"a}sion sowie die nachfolgende Thrombusbildung ist ein essentieller Prozess in der prim{\"a}ren H{\"a}mostase, der aber auch irreversible Gef{\"a}ßverschl{\"u}sse und damit Herzinfarkt oder Schlaganfall verursachen kann. Erst k{\"u}rzlich wurde beschrieben, dass der C-type lectin-like receptor 2 (CLEC-2) auf der Thrombozytenoberfl{\"a}che exprimiert wird, jedoch wurde f{\"u}r diesen Rezeptor noch keine Funktion in den Prozessen der H{\"a}mostase und Thrombose gezeigt. In der vorliegenden Arbeit wurde die Rolle von CLEC-2 in der Thrombozytenfunktion und Thrombusbildung im Mausmodel untersucht. In dem ersten Teil dieser Arbeit konnte gezeigt werden, dass die Behandlung von M{\"a}usen mit dem neu generierten monoklonalen Antik{\"o}rper INU1, der gegen murines CLEC-2 gerichtet ist, zu dem vollst{\"a}ndigen und hochspezifischen Verlust des Rezeptors in zirkulierenden Thrombozyten f{\"u}hrte, ein Prozess, der als „Immundepletion" bezeichnet wird. Die CLEC-2-defizienten Thrombozyten waren nicht mehr durch den CLEC-2-spezifischen Agonisten Rhodozytin aktivierbar, w{\"a}hrend die Aktivierung durch alle anderen getesteten Agonisten nicht beeintr{\"a}chtigt war. Dieser selektive Defekt f{\"u}hrte unter Flussbedingungen ex vivo zu stark verminderter Aggregatbildung der Thrombozyten. Außerdem zeigten in vivo-Thrombosestudien, dass die gebildeten Thromben instabil waren und vermehrt embolisierten. Infolgedessen war die CLEC-2 Defizienz mit einem deutlichen Schutz vor arterieller Thrombose verbunden. Außerdem ließ die in INU1-behandelten M{\"a}usen beobachtete variable Verl{\"a}ngerung der Blutungszeit auf einen moderaten h{\"a}mostatischen Defekt schließen. Diese Ergebnisse zeigen zum ersten Mal, dass CLEC-2 in vitro und in vivo signifikant zur Thrombusstabilit{\"a}t beitr{\"a}gt und eine essentielle Rolle in der H{\"a}mostase und arteriellen Thrombose spielt. Daher stellt CLEC-2 eine potentiell neue antithrombotische Zielstruktur dar, die in vivo inaktiviert werden kann. Diese in vivo-Herabregulierung von Thrombozytenoberfl{\"a}chenrezeptoren k{\"o}nnte einen vielversprechenden Ansatz f{\"u}r zuk{\"u}nftige antithrombotische Therapien darstellen. Der zweite Teil dieser Arbeit behandelte den Effekt einer Doppelimmundepletion der immunoreceptor tyrosine-based activation motiv (ITAM)- und hemITAM-gekoppelten Rezeptoren Glykoprotein (GP) VI und CLEC-2 auf H{\"a}mostase und Thrombose mittels einer Kombination der GPVI- beziehungsweise CLEC-2-spezifischen Antik{\"o}rper JAQ1 und INU1. Eine Einzeldepletion von GPVI oder CLEC-2 in vivo beeintr{\"a}chtigte nicht die Expression und Funktion des jeweils anderen Rezeptors. Eine gleichzeitige Behandlung mit beiden Antik{\"o}rpern f{\"u}hrte jedoch zu dem nachhaltigen Verlust der GPVI- und CLEC-2-vermittelten Signale in Thrombozyten, w{\"a}hrend andere Signalwege nicht betroffen waren. Im Gegensatz zu den Einzeldefizienzen, wiesen die GPVI/CLEC-2 doppeldefizienten M{\"a}use einen schwerwiegenden Blutungsph{\"a}notyp auf. Außerdem f{\"u}hrte die Behandlung zu einer starken Beeintr{\"a}chtigung der arteriellen Thrombusbildung, die die Effekte der Einzeldefizienzen weit {\"u}bertraf. Von Bedeutung ist auch, dass gleiche Ergebnisse in Gp6-/- M{\"a}usen gefunden wurden, die mittels INU1-Behandlung CLEC-2-depletiert wurden. Dies veranschaulicht, dass der Blutungsph{\"a}notyp nicht durch Sekund{\"a}reffekte der kombinierten Antik{\"o}rperbehandlung hervorgerufen wurde. Diese Daten deuten darauf hin, dass GPVI und CLEC-2 sowohl unabh{\"a}ngig voneinander als auch gleichzeitig in vivo von der Thrombozytenoberfl{\"a}che herabreguliert werden k{\"o}nnen und lassen unerwartete redundante Funktionen der beiden Rezeptoren in H{\"a}mostase und Thrombose erkennen. Da beide Rezeptoren, GPVI und CLEC-2, als neue antithrombotische Zielstrukturen diskutiert werden, k{\"o}nnten diese Ergebnisse wichtige Auswirkungen auf die Entwicklung von anti-GPVI oder anti-CLEC-2-basierenden Antithrombotika haben.},
  subject      = {Thrombozyt},
  language  = {en}
}
@phdthesis{Pleines2009,
  author    = {Pleines, Irina},
  title     = {The role of the Rho GTPases Rac1 and Cdc42 for platelet function and formation},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-48572},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2009},
  abstract  = {Platelet activation induces cytoskeletal rearrangements involving a change from discoid to spheric shape, secretion, and eventually adhesion and spreading on immobilized ligands. Small GTPases of the Rho family, such as Rac1 and Cdc42, are known to be involved in these processes by facilitating the formation of lamellipodia and filopodia, respectively. This thesis focuses on the role Rac1 and Cdc42 for platelet function and formation from their precursor cells, the megakaryocytes (MKs), using conditional knock-out mice. In the first part of the work, the involvement of Rac1 in the activation of the enzyme phospholipase (PL) C2 in the signaling pathway of the major platelet collagen receptor glycoprotein (GP) VI was investigated. It was found that Rac1 is essential for PLC2 activation independently of tyrosine phosphorylation of the enzyme, resulting in a specific platelet activation defect downstream of GPVI, whereas signaling of other activating receptors remains unaffected. Since Rac1-deficient mice were protected from arterial thrombosis in two different in vivo models, the GTPase might serve as a potential target for the development of new drugs for the treatment and prophylaxis of cardio- and cerebrovascular diseases. The second part of the thesis deals with the first characterization of MK- and platelet-specific Cdc42 knock-out mice. Cdc42-deficient mice displayed mild thrombo-cytopenia and platelet production from mutant MKs was markedly reduced. Unexpectedly, Cdc42-deficient platelets showed increased granule content and release upon activation, leading to accelerated thrombus formation in vitro and in vivo. Furthermore, Cdc42 was not generally required for filopodia formation upon platelet activation. Thus, these results indicate that Cdc42, unlike Rac1, is involved in multiple signaling pathways essential for proper platelet formation and function. Finally, the outcome of combined deletion of Rac1 and Cdc42 was studied. In contrast to single deficiency of either GTPase, platelet production from double-deficient MKs was virtually abrogated, resulting in dramatic macrothrombocytopenia in the animals. Formed platelets were largely non-functional leading to a severe hemostatic defect and defective thrombus formation in double-deficient mice in vivo. These results demonstrate for the first time a functional redundancy of Rac1 and Cdc42 in the hematopoietic system.},
  subject      = {Thrombose},
  language  = {en}
}
@phdthesis{Spaeth2020,
  author    = {Sp{\"a}th, Leonie},
  title     = {Vermeidung von {\"U}berversorgung am Lebensende am Beispiel der Thromboembolieprophylaxe nach Einf{\"u}hrung einer Klug Entscheiden-Initiative},
  doi       = {10.25972/OPUS-19958},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-199585},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2020},
  abstract  = {Fragestellung und wissenschaftlicher Hintergrund: Ankn{\"u}pfend an die S3-Leitlinie der Deutschen Gesellschaft f{\"u}r Palliativmedizin und an die internationale Choosing Wisely-Kampagne sowie die deutsche Klug Entscheiden-Initiative wurde auf der Palliativstation im Universit{\"a}tsklinikum W{\"u}rzburg im Juni 2015 das „Klug Entscheiden am Lebensende"-Programm (= KEL-Programm) eingef{\"u}hrt. Der Fokus der retrospektiven Patientenaktenanalyse lag auf der Thromboembolieprophylaxe in der Sterbephase (die drei bis sieben Tage vor dem eintretenden Tod) durch das NMH Natrium-Enoxaparin. Ein Zusammenhang zwischen tumorbedingten Erkrankungen und thromboembolischen Komplikationen ist unumstritten, konkurrierende Empfehlungen in verschiedenen Leitlinien erschweren jedoch die Entscheidungsfindung zur Indikationsstellung am Lebensende im palliativen Setting. Diese Untersuchung sollte zur wissenschaftlichen Aufarbeitung der Polymedikation am Lebensende am Beispiel der Thromboembolieprophylaxe beitragen und die praktische Umsetzung des KEL-Programms in der t{\"a}glichen Praxis beleuchten. Methodik: Es wurden zwei Patientengruppen untersucht: die Kontrollgruppe (KoG, n = 107) vor der Einf{\"u}hrung des KEL-Programmes sowie die Klug-Entscheiden-Gruppe (KEG, n = 85) nach der Implementierung des Programms. Es wurden jeweils nur auf der Station Verstorbene betrachtet. Die Patientendaten und klinischen Informationen wurden der {\"a}rztlichen und pflegerischen Dokumentation entnommen, die in den Patientenakten auf der Palliativstation sortiert vorlagen. Mithilfe eines Erfassungsbogens wurde die subkutane Applikation der NMH jeweils am Aufnahmetag, drei bis sieben Tage und zwei Tage vor dem Tod sowie am Todestag festgehalten. Zus{\"a}tzlich wurden klinische Symptome notiert, die auf ein thromboembolisches Ereignis hinweisen k{\"o}nnten. Des Weiteren wurde die Verordnung der vier essentiellen Medikamente (Opioide, Benzodiazepine, Neuroleptika, Anticholinergika) zur Symptomkontrolle in der Sterbewoche sowie Symptome der Patienten erhoben. Ergebnis: Insgesamt erhielten am Aufnahmetag auf der Palliativstation 44,9 \% der Patienten in der Kontrollgruppe das NMH Na-Enoxaparin und nur 29,4 \% der Patienten in der Klug-Entscheiden-Gruppe und zeigte damit einen signifikanten Unterschied (p = 0,029; Chi-Quadrat-Test). Dieser Trend setzte sich auch in der gesamten Sterbewoche fort. Drei bis sieben Tage vor dem Tod wurde 52,6 \% der Patienten in der Kontrollgruppe Na-Enoxaparin appliziert, in der Klug-Entscheiden-Gruppe erhielten es nur 28,6 \% (p = 0,004; Chi-Quadrat-Test). Zwei Tage vor dem Tod wurden im ersten Zeitraum 30,8 \%, im zweiten Zeitraum 5,5 \% der Patienten mit Na-Enoxaparin therapiert (p < 0,001; Exakter Test nach Fisher). Am Todestag wurde es in der Kontrollgruppe 12,1 \% gegeben und in der Klug-Entscheiden-Gruppe 3,5 \% (p = 0,037; Exakter Test nach Fisher). In der {\"a}rztlichen und pflegerischen Dokumentation wurde keine H{\"a}ufung von Hinweisen auf thromboembolische Ereignissen festgestellt (KoG: 7,5\%, KEG: 5,9\%, p = 0,662; Chi-Quadrat-Test). Schmerzen und Dyspnoe traten in vergleichbarer Intensit{\"a}t auf, die Symptomauspr{\"a}gung der Unruhe unterschied sich signifikant. Die vier essenziellen Medikamente zur Symptomlinderung in der Sterbephase waren in unver{\"a}ndertem Umfang erforderlich. Schlussfolgerung: Die Ergebnisse deuten darauf hin, dass durch individuelle Entscheidungen bez{\"u}glich des Absetzens der Thromboembolieprophylaxe am Lebensende kein Anstieg an thromboembolischen Komplikationen bef{\"u}rchtet werden muss. Auf diese Weise kann ein Beitrag zur Vermeidung von Polymedikation am Lebensende geleistet werden, ohne dass die Versorgungsqualit{\"a}t darunter zu leiden hat. Die erfolgreiche Implementierung des W{\"u}rzburger KEL-Programms und diese Dissertation sollen zur weiteren Reflexion {\"u}ber {\"a}rztliches Handeln am Lebensende beitragen und ermutigen. {\"A}rzte aller Fachrichtungen sind weiterhin f{\"u}r die Problematik der {\"U}berversorgung zu sensibilisieren und Empfehlungen im Sinne der Klug Entscheiden-Initiative sollen in die t{\"a}gliche Praxis eingebunden werden.},
  subject      = {Palliativmedizin},
  language  = {de}
}