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Erschienen in: Zeitschrift für Gerontologie und Geriatrie 3/2016

10.02.2016 | Vorhofflimmern | Übersichten

Neue orale Antikoagulanzien zur Prophylaxe von Schlaganfällen

Ergebnis einer Expertenkonferenz zum praktischen Einsatz bei geriatrischen Patienten

verfasst von: Privatdozent Dr. Philipp Bahrmann, MHBA, Fred Harms, Christian Martin Schambeck, Martin Wehling, Jürgen Flohr

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 3/2016

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Zusammenfassung

Geriatrische Patienten mit nichtvalvulärem Vorhofflimmern (VHF) erhalten zunehmend neue orale Antikoagulanzien (NOAK) zur Schlaganfallprophylaxe. Das vorliegende Manuskript berichtet die Ergebnisse einer Expertenrunde zum praktischen Einsatz der NOAK bei geriatrischen Patienten. Eine interdisziplinäre Expertengruppe diskutierte die aktuelle Situation der Schlaganfallprävention bei geriatrischen Patienten und ihr praktisches Management in der täglichen klinischen Praxis. Das Thema wurde durch gezielte Impulsreferate und kritische Analyse als Grundlage für den Expertenkonsens diskutiert. Die wichtigsten Aspekte sind in diesem Beitrag zusammengefasst.In der VHF-Leitlinie der „European Society of Cardiology“ (ESC) werden für die Antikoagulation bei Patienten mit nichtvalvulärem VHF NOAK bevorzugt und Vitamin-K-Antagonisten (VKA) als Alternative empfohlen. Momentan finden die Faktor-Xa-Inhibitoren Apixaban und Rivaroxaban und der Thrombininhibitor Dabigatran als NOAK bei VHF klinische Anwendung. Für diese Medikamente bestehen viele Gemeinsamkeiten, für die differenzierte Pharmakotherapie aber auch wichtige Unterschiede. Die NOAK haben bei geriatrischen Patienten eine Reihe von Vorteilen gegenüber den VKA, vorrangig durch das bessere Nutzen-Risiko-Verhältnis aufgrund einer verminderten Zahl von Blutungsereignissen, und ein insgesamt geringeres Risiko für Arzneimittelinteraktionen. Hervorzuheben ist auch die einfachere Handhabung der NOAK im Alltag (kein INR-Monitoring erforderlich und unkompliziertere Unterbrechungen der Therapie bei geplanten Interventionen). Für geriatrische Patienten sollten vorzugsweise NOAK gewählt werden, die auch bei reduzierter Nierenfunktion eingesetzt werden können. Spiegelbestimmungen der NOAK werden zwar noch nicht flächendeckend angeboten, sind jedoch nicht mehr teuer und sollten bei Erfordernis (z. B. Adhärenzkontrolle bei Demenz) auch durch den niedergelassenen Arzt veranlasst werden. Eine regelmäßige Überprüfung der Indikationsstellung der NOAK (wie auch aller anderen Medikamente des Patienten) ist unabdingbar. Insgesamt sollten NOAK den hierfür geeigneten Patienten nicht vorenthalten werden.
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Metadaten
Titel
Neue orale Antikoagulanzien zur Prophylaxe von Schlaganfällen
Ergebnis einer Expertenkonferenz zum praktischen Einsatz bei geriatrischen Patienten
verfasst von
Privatdozent Dr. Philipp Bahrmann, MHBA
Fred Harms
Christian Martin Schambeck
Martin Wehling
Jürgen Flohr
Publikationsdatum
10.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 3/2016
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-016-1027-z

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