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Erschienen in: CME 9/2017

20.09.2017 | Direkte orale Antikoagulanzien | CME Fortbildung

Diagnose und Behandlung der Lungenembolie

Einsatz neuer oraler Antikoagulanzien (NOAK)

verfasst von: Dr. med. Matthias Hecker, Ph.D., Prof. Dr. Konstantin Mayer, Dr. med. Pascal Bauer

Erschienen in: CME | Ausgabe 9/2017

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Zusammenfassung

Die Lungenembolie stellt eine relativ häufige und potenziell tödliche Erkrankung dar. Vor dem Hintergrund der hohen klinischen Relevanz sind eine rasche und zielführende Risikostratifizierung, Diagnostik und Therapie von entscheidender Bedeutung. Die aktuelle europäische Leitlinie zur Diagnostik und Therapie der akuten Lungenembolie bietet zu diesem Thema eine wertvolle und praxisnahe Unterstützung und bildet die Grundlage des vorliegenden Artikels. Besonderer thematischer Schwerpunkt dieser Übersichtsarbeit soll auf dem Einsatz neuer oraler Antikoagulanzien in der Therapie akuter Lungenembolien liegen.
Literatur
1.
Zurück zum Zitat Agnelli G, Buller HR, Cohen A et al (2013) Oral Apixaban for the Treatment of Acute Venous Thromboembolism. N Engl J Med 369:799–808.CrossRefPubMed Agnelli G, Buller HR, Cohen A et al (2013) Oral Apixaban for the Treatment of Acute Venous Thromboembolism. N Engl J Med 369:799–808.CrossRefPubMed
2.
Zurück zum Zitat Agnelli G, Buller HR, Cohen A et al (2013) Apixaban for extended treatment of venous thromboembolism. N Engl J Med 368:699–708.CrossRefPubMed Agnelli G, Buller HR, Cohen A et al (2013) Apixaban for extended treatment of venous thromboembolism. N Engl J Med 368:699–708.CrossRefPubMed
3.
Zurück zum Zitat Aujesky D, Obrosky DS, Stone RA et al (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172:1041–1046.CrossRefPubMedPubMedCentral Aujesky D, Obrosky DS, Stone RA et al (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172:1041–1046.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Castellucci LA, Cameron C, Le Gal G et al (2014) Clinical and Safety Outcomes Associated With Treatment of Acute Venous Thromboembolism. JAMA 312:1122.CrossRefPubMed Castellucci LA, Cameron C, Le Gal G et al (2014) Clinical and Safety Outcomes Associated With Treatment of Acute Venous Thromboembolism. JAMA 312:1122.CrossRefPubMed
5.
Zurück zum Zitat Cohen AT, Agnelli G, Anderson FA et al (2007) Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 98:756–764.PubMed Cohen AT, Agnelli G, Anderson FA et al (2007) Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 98:756–764.PubMed
6.
Zurück zum Zitat Cohen AT, Hamilton M, Mitchell SA et al (2015) Comparison of the Novel Oral Anticoagulants Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in the Initial and Long-Term Treatment and Prevention of Venous Thromboembolism: Systematic Review and Network Meta-Analysis. PLoS One 10:e0144856.CrossRefPubMedPubMedCentral Cohen AT, Hamilton M, Mitchell SA et al (2015) Comparison of the Novel Oral Anticoagulants Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in the Initial and Long-Term Treatment and Prevention of Venous Thromboembolism: Systematic Review and Network Meta-Analysis. PLoS One 10:e0144856.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat EINSTEIN—PE Investigators, Büller HR, Prins MH et al (2012) Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med 366:1287–1297.CrossRef EINSTEIN—PE Investigators, Büller HR, Prins MH et al (2012) Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med 366:1287–1297.CrossRef
8.
Zurück zum Zitat EINSTEIN Investigators, Bauersachs R, Berkowitz SD et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–510.CrossRef EINSTEIN Investigators, Bauersachs R, Berkowitz SD et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–510.CrossRef
9.
Zurück zum Zitat Hecker M, Bandorski D, Hecker A (2012) Extrakorporale Lungenunterstützungsverfahren. Medizinische Klin - Intensivmed und Notfallmedizin 107:491–501.CrossRef Hecker M, Bandorski D, Hecker A (2012) Extrakorporale Lungenunterstützungsverfahren. Medizinische Klin - Intensivmed und Notfallmedizin 107:491–501.CrossRef
10.
Zurück zum Zitat Hecker M, Sommer N, Hecker A et al (2015) Lungenembolie. Medizinische Klin - Intensivmed und Notfallmedizin 1–15. Hecker M, Sommer N, Hecker A et al (2015) Lungenembolie. Medizinische Klin - Intensivmed und Notfallmedizin 1–15.
11.
12.
Zurück zum Zitat Hokusai-VTE Investigators, Büller HR, Décousus H et al (2013) Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. N Engl J Med 369:1406–1415.CrossRef Hokusai-VTE Investigators, Büller HR, Décousus H et al (2013) Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. N Engl J Med 369:1406–1415.CrossRef
13.
Zurück zum Zitat van der Hulle T, Kooiman J, den Exter PL et al (2014) Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis. J Thromb Haemost 12:320–328.CrossRefPubMed van der Hulle T, Kooiman J, den Exter PL et al (2014) Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis. J Thromb Haemost 12:320–328.CrossRefPubMed
14.
Zurück zum Zitat Kang N, Sobieraj DM (2014) Indirect treatment comparison of new oral anticoagulants for the treatment of acute venous thromboembolism. Thromb Res 133:1145–1151.CrossRefPubMed Kang N, Sobieraj DM (2014) Indirect treatment comparison of new oral anticoagulants for the treatment of acute venous thromboembolism. Thromb Res 133:1145–1151.CrossRefPubMed
15.
Zurück zum Zitat Kelm C, Engels K (2017) [Perioperative management of patients on NOACs]. Med Klin Intensivmed Notfmed 112:125–128.CrossRefPubMed Kelm C, Engels K (2017) [Perioperative management of patients on NOACs]. Med Klin Intensivmed Notfmed 112:125–128.CrossRefPubMed
16.
Zurück zum Zitat Konstantinides S V (2014) 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3145–3146.CrossRefPubMed Konstantinides S V (2014) 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3145–3146.CrossRefPubMed
17.
Zurück zum Zitat Mani H, Hesse C, Stratmann G, Lindhoff-Last E (2011) Rivaroxaban differentially influences ex vivo global coagulation assays based on the administration time. Thromb Haemost 106:156–164.CrossRefPubMed Mani H, Hesse C, Stratmann G, Lindhoff-Last E (2011) Rivaroxaban differentially influences ex vivo global coagulation assays based on the administration time. Thromb Haemost 106:156–164.CrossRefPubMed
18.
Zurück zum Zitat Mantha S, Ansell J (2015) Indirect comparison of dabigatran, rivaroxaban, apixaban and edoxaban for the treatment of acute venous thromboembolism. J Thromb Thrombolysis 39:155–165.CrossRefPubMed Mantha S, Ansell J (2015) Indirect comparison of dabigatran, rivaroxaban, apixaban and edoxaban for the treatment of acute venous thromboembolism. J Thromb Thrombolysis 39:155–165.CrossRefPubMed
19.
Zurück zum Zitat Meneveau N, Seronde M-F, Blonde M-C et al (2006) Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest 129:1043–1050.CrossRefPubMed Meneveau N, Seronde M-F, Blonde M-C et al (2006) Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest 129:1043–1050.CrossRefPubMed
20.
Zurück zum Zitat Meyer G, Vicaut E, Danays T et al (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402–1411.CrossRefPubMed Meyer G, Vicaut E, Danays T et al (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402–1411.CrossRefPubMed
21.
Zurück zum Zitat Pollack CVJ, Reilly PA, Eikelboom J et al (2015) Idarucizumab for Dabigatran Reversal. N Engl J Med 373:511–520.CrossRefPubMed Pollack CVJ, Reilly PA, Eikelboom J et al (2015) Idarucizumab for Dabigatran Reversal. N Engl J Med 373:511–520.CrossRefPubMed
22.
Zurück zum Zitat Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJM (2008) Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 6:632–637.CrossRefPubMed Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJM (2008) Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 6:632–637.CrossRefPubMed
23.
Zurück zum Zitat Rafflenbeul E, Muller-Ehmsen J (2017) [Vitamin K antagonists: Is their prescription really „medical malpractice“ today?]. Internist (Berl) 58:90–99.CrossRef Rafflenbeul E, Muller-Ehmsen J (2017) [Vitamin K antagonists: Is their prescription really „medical malpractice“ today?]. Internist (Berl) 58:90–99.CrossRef
24.
Zurück zum Zitat Remy-Jardin M, Pistolesi M, Goodman LR et al (2007) Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology 245:315–329.CrossRefPubMed Remy-Jardin M, Pistolesi M, Goodman LR et al (2007) Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology 245:315–329.CrossRefPubMed
25.
Zurück zum Zitat Ridker PM, Goldhaber SZ, Danielson E et al (2003) Long-Term, Low-Intensity Warfarin Therapy for the Prevention of Recurrent Venous Thromboembolism. N Engl J Med 348:1425–1434.CrossRefPubMed Ridker PM, Goldhaber SZ, Danielson E et al (2003) Long-Term, Low-Intensity Warfarin Therapy for the Prevention of Recurrent Venous Thromboembolism. N Engl J Med 348:1425–1434.CrossRefPubMed
26.
Zurück zum Zitat Righini M, Van Es J, Den Exter PL et al (2014) Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 311:1117–1124.CrossRefPubMed Righini M, Van Es J, Den Exter PL et al (2014) Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 311:1117–1124.CrossRefPubMed
27.
Zurück zum Zitat van Ryn J, Stangier J, Haertter S et al (2010) Dabigatran etexilate—a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 103:1116–1127.CrossRefPubMed van Ryn J, Stangier J, Haertter S et al (2010) Dabigatran etexilate—a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 103:1116–1127.CrossRefPubMed
28.
Zurück zum Zitat Schulman S, Crowther MA (2012) How I treat with anticoagulants in 2012: new and old anticoagulants, and when and how to switch. Blood 119:3016–3023.CrossRefPubMed Schulman S, Crowther MA (2012) How I treat with anticoagulants in 2012: new and old anticoagulants, and when and how to switch. Blood 119:3016–3023.CrossRefPubMed
29.
Zurück zum Zitat Schulman S, Kakkar AK, Goldhaber SZ et al (2014) Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 129:764–72.CrossRefPubMed Schulman S, Kakkar AK, Goldhaber SZ et al (2014) Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 129:764–72.CrossRefPubMed
30.
Zurück zum Zitat Schulman S, Kearon C, Kakkar AK et al (2009) Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism. N Engl J Med 361:2342–2352.CrossRefPubMed Schulman S, Kearon C, Kakkar AK et al (2009) Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism. N Engl J Med 361:2342–2352.CrossRefPubMed
31.
Zurück zum Zitat Schulman S, Kearon C, Kakkar AK et al (2013) Extended Use of Dabigatran, Warfarin, or Placebo in Venous Thromboembolism. N Engl J Med 368:709–718.CrossRefPubMed Schulman S, Kearon C, Kakkar AK et al (2013) Extended Use of Dabigatran, Warfarin, or Placebo in Venous Thromboembolism. N Engl J Med 368:709–718.CrossRefPubMed
32.
Zurück zum Zitat Siegal DM, Curnutte JT, Connolly SJ et al (2015) Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med 373:2413–2424.CrossRefPubMed Siegal DM, Curnutte JT, Connolly SJ et al (2015) Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med 373:2413–2424.CrossRefPubMed
33.
Zurück zum Zitat Sostman HD, Miniati M, Gottschalk A et al (2008) Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 49:1741–1748.CrossRefPubMed Sostman HD, Miniati M, Gottschalk A et al (2008) Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 49:1741–1748.CrossRefPubMed
Metadaten
Titel
Diagnose und Behandlung der Lungenembolie
Einsatz neuer oraler Antikoagulanzien (NOAK)
verfasst von
Dr. med. Matthias Hecker, Ph.D.
Prof. Dr. Konstantin Mayer
Dr. med. Pascal Bauer
Publikationsdatum
20.09.2017
Verlag
Springer Medizin
Erschienen in
CME / Ausgabe 9/2017
Print ISSN: 1614-371X
Elektronische ISSN: 1614-3744
DOI
https://doi.org/10.1007/s11298-017-5986-1

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