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Erschienen in: Notfall + Rettungsmedizin 3/2017

12.04.2017 | Direkte orale Antikoagulanzien | CME

Nicht-Vitamin-K-abhängige orale Antikoagulanzien

Notfallmanagement bei Patienten mit Blutungen unter oraler Antikoagulation

verfasst von: Priv.-Doz. Dr. med. J. Koscielny, Dr. C. Rosenthal, Prof. Dr. C. von Heymann

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 3/2017

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Zusammenfassung

Trotz des breiten Einsatzes nicht-Vitamin-K-abhängiger oraler Antikoagulanzien (NOAK) sowie Empfehlungen von Zulassungsbehörden und interdisziplinären Expertengremien zum Umgang in der Blutungssituation unter NOAK-Antikoagulation besteht insbesondere in Krankenhäusern ohne hämostaseologischen Schwerpunkt große Handlungsunsicherheit. Bei aus klinischer Sicht leichten Blutungen sind die medizinische Überwachung dieser Patienten und die Verzögerung der nächsten Einnahme oder das passagere Absetzen anzuraten. Bei mittelschweren bis schweren Blutungen richten sich die primären Maßnahmen auf die Stabilisierung der Herz-Kreislauf-Funktion und parallel auf die Behandlung, je nach Lokalisation des Blutungsherdes. Vital bedrohliche, z. B. intrakranielle Blutungen erfordern neben den Maßnahmen der hämodynamischen Stabilisierung ein spezielles Hämostasemanagement, das vorwiegend klinisch orientiert sein sollte.
Fußnoten
1
C „congestive heart failure“ (Herzinsuffizienz), H Hypertension, A 2 Alter ≥75 Jahre (doppelt), D Diabetes mellitus, S2 „stroke“ (Schlaganfall; doppelt), transitorische ischämische Attacke oder Thromboembolie, V vaskuläre Erkrankungen wie periphere arterielle Verschlusskrankheit oder Herzinfarkt, A Alter 65 bis 74 Jahre, Sc „sex category“ (weibliches Geschlecht).
 
Literatur
1.
Zurück zum Zitat Camm AJ, Lip GY, De Caterina R et al (2012) focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation-developed with special contribution of the European Heart Rhythm Association. Europace 14:1385–1413CrossRefPubMed Camm AJ, Lip GY, De Caterina R et al (2012) focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation-developed with special contribution of the European Heart Rhythm Association. Europace 14:1385–1413CrossRefPubMed
2.
Zurück zum Zitat Connolly SJ, Ezekowitz MD, Yussuf S, Reilley PA, Wallentin L (2010) Newly identified events in the RE-LY trial. N Engl J Med 363:1875–1876CrossRefPubMed Connolly SJ, Ezekowitz MD, Yussuf S, Reilley PA, Wallentin L (2010) Newly identified events in the RE-LY trial. N Engl J Med 363:1875–1876CrossRefPubMed
3.
Zurück zum Zitat Chai-Adisaksopha C, Crowther M, Isayama T, Lim W (2014) The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood 124(15):2450–2458CrossRefPubMed Chai-Adisaksopha C, Crowther M, Isayama T, Lim W (2014) The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood 124(15):2450–2458CrossRefPubMed
4.
Zurück zum Zitat Dentali F, Riva N, Crowther M, Turpie AG, Lip GY, Ageno W (2012) Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature. Circulation 126:2381–2391CrossRefPubMed Dentali F, Riva N, Crowther M, Turpie AG, Lip GY, Ageno W (2012) Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature. Circulation 126:2381–2391CrossRefPubMed
5.
Zurück zum Zitat Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W et al (2015) Updated European Heart Rhythm Association (EHRA) practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 17:1467–1507CrossRefPubMed Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W et al (2015) Updated European Heart Rhythm Association (EHRA) practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 17:1467–1507CrossRefPubMed
6.
Zurück zum Zitat Kovacs RJ, Flaker G, Saxonhouse S, Doherty J, Birtcher K, Cuker A, Davidson B, Giugliano R, Granger C, Jaffer A, Metha B, Nutescu E, Williams K (2015) Practical management of anticoagulation in patients with atrial fibrillation. J Am Coll Cardiol 65(13):1340–1360CrossRefPubMed Kovacs RJ, Flaker G, Saxonhouse S, Doherty J, Birtcher K, Cuker A, Davidson B, Giugliano R, Granger C, Jaffer A, Metha B, Nutescu E, Williams K (2015) Practical management of anticoagulation in patients with atrial fibrillation. J Am Coll Cardiol 65(13):1340–1360CrossRefPubMed
7.
Zurück zum Zitat Cotton B, McCarthy J, Holcomb J (2011) Acutely injured patients on dabigatran. N Engl J Med 365(21):2039–2040CrossRefPubMed Cotton B, McCarthy J, Holcomb J (2011) Acutely injured patients on dabigatran. N Engl J Med 365(21):2039–2040CrossRefPubMed
8.
Zurück zum Zitat Gomez-Outes A, Terleira-Fernandez A, Lecumberri R, Suarez-Gea M, Vargas-Castrillon E (2014) Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis. Thromb Res 134(4):774–782CrossRefPubMed Gomez-Outes A, Terleira-Fernandez A, Lecumberri R, Suarez-Gea M, Vargas-Castrillon E (2014) Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis. Thromb Res 134(4):774–782CrossRefPubMed
9.
Zurück zum Zitat Caldeira D, Rodrigues F, Barra M, Santos AT, De Abreu D, Goncalves N, Pinto F, Ferreira J, Costa J (2015) Non-vitamin K antagonist oral anticoagulants and major bleeding-related fatality in patients with atrial fibrillation and venous thromboembolism: a systematic review and meta-analysis. Heart 101:1204–1211CrossRefPubMed Caldeira D, Rodrigues F, Barra M, Santos AT, De Abreu D, Goncalves N, Pinto F, Ferreira J, Costa J (2015) Non-vitamin K antagonist oral anticoagulants and major bleeding-related fatality in patients with atrial fibrillation and venous thromboembolism: a systematic review and meta-analysis. Heart 101:1204–1211CrossRefPubMed
10.
Zurück zum Zitat Ruff C, Giugliano R, Braunwald E, Hoffmann E, Deenadayalu N, Ezekowitz M, Camm A, Weitz J, Lewis B, Parkhomenko A, Yamashita T, Antman E (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383(9921):955–962CrossRefPubMed Ruff C, Giugliano R, Braunwald E, Hoffmann E, Deenadayalu N, Ezekowitz M, Camm A, Weitz J, Lewis B, Parkhomenko A, Yamashita T, Antman E (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383(9921):955–962CrossRefPubMed
11.
Zurück zum Zitat Inui T, Parina R, Chang D, Inui T, Coimbra R (2014) Mortality after ground-level fall in the elderly patients taking oral anticoagulation for atrial fibrillation/flutter: A long-term analysis of risks versus benefit. J Trauma Acute Care Surg 76(3):642–649CrossRefPubMed Inui T, Parina R, Chang D, Inui T, Coimbra R (2014) Mortality after ground-level fall in the elderly patients taking oral anticoagulation for atrial fibrillation/flutter: A long-term analysis of risks versus benefit. J Trauma Acute Care Surg 76(3):642–649CrossRefPubMed
12.
Zurück zum Zitat Peck KA, Calvo R, Schlechter M, Sise C, Kahl J, Shackford M, Shackford S, Sise M, Blaskiewicz D (2014) The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. J Trauma Acute Care Surg 76(2):431–436CrossRefPubMed Peck KA, Calvo R, Schlechter M, Sise C, Kahl J, Shackford M, Shackford S, Sise M, Blaskiewicz D (2014) The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. J Trauma Acute Care Surg 76(2):431–436CrossRefPubMed
14.
Zurück zum Zitat Lödgers T, Lefering R, Schneppendahl J, Alldinger I, Witte I, Windolf J, Flohé S (2010) Abbruch der Schockraumdiagnostik und Notfalloperation beim Polytrauma: Inzidenz und klinische Relevanz. Unfallchirurg 10:832–838 Lödgers T, Lefering R, Schneppendahl J, Alldinger I, Witte I, Windolf J, Flohé S (2010) Abbruch der Schockraumdiagnostik und Notfalloperation beim Polytrauma: Inzidenz und klinische Relevanz. Unfallchirurg 10:832–838
15.
Zurück zum Zitat Wutzler S, Maegele M, Marzi I, Spanholtz T, Wafaisade A, Lefering R (2009) TR-DGU. Association of preexisting medical conditions with in-hospital mortality in multiple-trauma patients. J Am Coll Surg 209(1):75–81CrossRefPubMed Wutzler S, Maegele M, Marzi I, Spanholtz T, Wafaisade A, Lefering R (2009) TR-DGU. Association of preexisting medical conditions with in-hospital mortality in multiple-trauma patients. J Am Coll Surg 209(1):75–81CrossRefPubMed
16.
Zurück zum Zitat Batchelor JS, Grayson A (2012) A meta-analysis to determine the effect of anticoagulation on mortality in patients with blunt head trauma. Br J Neurosurg 26(4):525–530CrossRefPubMed Batchelor JS, Grayson A (2012) A meta-analysis to determine the effect of anticoagulation on mortality in patients with blunt head trauma. Br J Neurosurg 26(4):525–530CrossRefPubMed
17.
Zurück zum Zitat Stangier J, Rathgen K, Stahle H, Mazur D (2010) Influence of renal impairment on the pharmacokinetics and pharmakodynamics of oral dabigatran etexilate: An open-label, parallel-group, single-centre study. Clin Pharmacokinet 49:259–268CrossRefPubMed Stangier J, Rathgen K, Stahle H, Mazur D (2010) Influence of renal impairment on the pharmacokinetics and pharmakodynamics of oral dabigatran etexilate: An open-label, parallel-group, single-centre study. Clin Pharmacokinet 49:259–268CrossRefPubMed
18.
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 103:1116–1127CrossRefPubMed 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 103:1116–1127CrossRefPubMed
19.
Zurück zum Zitat Wang Y, Bajorek B (2014) New oral anticoagulants in practice: phamacological and practical considerations. Am J Cardiovasc Drugs 14(3):175–189CrossRefPubMed Wang Y, Bajorek B (2014) New oral anticoagulants in practice: phamacological and practical considerations. Am J Cardiovasc Drugs 14(3):175–189CrossRefPubMed
22.
Zurück zum Zitat FDA Drug Safety Communication (2014) FDA study of Medicare patients finds risks lower for stroke and death but higher for gastrointestinal bleeding with Pradaxa (dabigatran) compared to warfarin. Update on the risk for serious bleeding events with the anticoagulant Pradaxa (dabigatran) that was issued on November 2, 2012. http://www.fda.gov/Drugs/DrugSafety/ucm326580.htm (Erstellt: 13. Mai 2014) FDA Drug Safety Communication (2014) FDA study of Medicare patients finds risks lower for stroke and death but higher for gastrointestinal bleeding with Pradaxa (dabigatran) compared to warfarin. Update on the risk for serious bleeding events with the anticoagulant Pradaxa (dabigatran) that was issued on November 2, 2012. http://​www.​fda.​gov/​Drugs/​DrugSafety/​ucm326580.​htm (Erstellt: 13. Mai 2014)
23.
Zurück zum Zitat Efird LM, Mishkin DS, Berlowitz DR, Ash AS, Hylek EM, Ozonoff A, Reisman JI, Zhao S, Jasuja GK, Rose AJ (2014) Stratifying the risks of oral anticoagulation in patients with liver disease. Circ Cardiovasc Qual Outcomes 7(3):461–467CrossRefPubMed Efird LM, Mishkin DS, Berlowitz DR, Ash AS, Hylek EM, Ozonoff A, Reisman JI, Zhao S, Jasuja GK, Rose AJ (2014) Stratifying the risks of oral anticoagulation in patients with liver disease. Circ Cardiovasc Qual Outcomes 7(3):461–467CrossRefPubMed
24.
Zurück zum Zitat Khadzhynov D, Wagner F, Formella S, Wiegert E, Moschetti V, Slowinski T et al (2013) Effective elimination of dabigatran by haemodialysis. A phase I single-centre study in patients with end-stage renal disease. Thromb Haemost 109:596–605CrossRefPubMed Khadzhynov D, Wagner F, Formella S, Wiegert E, Moschetti V, Slowinski T et al (2013) Effective elimination of dabigatran by haemodialysis. A phase I single-centre study in patients with end-stage renal disease. Thromb Haemost 109:596–605CrossRefPubMed
25.
Zurück zum Zitat Chai-Adisaksopha C, Hillis C, Lim W, Boonyawat K, Moffat K, Crowther M (2015) Hemodialysis for the treatment of dabigatran-associated bleeding: a case report and systematic review. J Thromb Haemost 13(10):1790–1798CrossRefPubMed Chai-Adisaksopha C, Hillis C, Lim W, Boonyawat K, Moffat K, Crowther M (2015) Hemodialysis for the treatment of dabigatran-associated bleeding: a case report and systematic review. J Thromb Haemost 13(10):1790–1798CrossRefPubMed
26.
Zurück zum Zitat Reilly P, Lehr T, Haertter S, Connolly S, Yusuf S, Eikelboom J, Ezekowitz M, Nehmiz G, Wang S, Wallentin L, RE-LY Investigators (2014) The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in artrial fibrillation patients: the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J Am Coll Cardiol 63(4):321–328CrossRefPubMed Reilly P, Lehr T, Haertter S, Connolly S, Yusuf S, Eikelboom J, Ezekowitz M, Nehmiz G, Wang S, Wallentin L, RE-LY Investigators (2014) The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in artrial fibrillation patients: the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J Am Coll Cardiol 63(4):321–328CrossRefPubMed
27.
Zurück zum Zitat Sibbing D, Spannagl M (2014) Direct oral anticoagulants and antiplatelet agents. Hamostaseologie 34(1):78–84CrossRefPubMed Sibbing D, Spannagl M (2014) Direct oral anticoagulants and antiplatelet agents. Hamostaseologie 34(1):78–84CrossRefPubMed
28.
Zurück zum Zitat Cuker A, Siegal DM, Crowther MA, Garcia DA (2014) Laboratory measurements of the anticoagulant activity of the non-vitamin K oral anticoagulants. J Am Coll Cardiol 64(11):1128–1139CrossRefPubMedPubMedCentral Cuker A, Siegal DM, Crowther MA, Garcia DA (2014) Laboratory measurements of the anticoagulant activity of the non-vitamin K oral anticoagulants. J Am Coll Cardiol 64(11):1128–1139CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Baglin T (2013) The role of the laboratory in treatment with new oral anticoagulants. J Thromb Haemost 11(Suppl 1):122–128CrossRefPubMed Baglin T (2013) The role of the laboratory in treatment with new oral anticoagulants. J Thromb Haemost 11(Suppl 1):122–128CrossRefPubMed
30.
Zurück zum Zitat Harenberg J, Krämer S, Du S, Weiss C, Krämer R (2013) Concept of a point of care test to detect new oral anticoagulants in urine samples. Thromb J 11(1):15CrossRefPubMedPubMedCentral Harenberg J, Krämer S, Du S, Weiss C, Krämer R (2013) Concept of a point of care test to detect new oral anticoagulants in urine samples. Thromb J 11(1):15CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Dias JD, Norem K, Doorneweerd D, Thurer RL, Popovsky M, Olmert L (2015) Use of thromboelastography (TEG) for the detection of new oral anticoagulants. Arch Pathol Lab Med 139(5):665–673CrossRefPubMed Dias JD, Norem K, Doorneweerd D, Thurer RL, Popovsky M, Olmert L (2015) Use of thromboelastography (TEG) for the detection of new oral anticoagulants. Arch Pathol Lab Med 139(5):665–673CrossRefPubMed
32.
Zurück zum Zitat Dinkelaar J, Patiwael S, Harenberg J, Leyte A, Brinkmann HJ (2014) Global coagulation tests: Their applicability for measuring direct factor Xa- and thrombin inhibition and reversal of anticoagulation by prothrombin complex concentrate. Clin Chem Lab Med 52(11):1615–1623PubMed Dinkelaar J, Patiwael S, Harenberg J, Leyte A, Brinkmann HJ (2014) Global coagulation tests: Their applicability for measuring direct factor Xa- and thrombin inhibition and reversal of anticoagulation by prothrombin complex concentrate. Clin Chem Lab Med 52(11):1615–1623PubMed
33.
Zurück zum Zitat Van Ryn J, Strangier 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 103:1116–1127CrossRefPubMed Van Ryn J, Strangier 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 103:1116–1127CrossRefPubMed
34.
Zurück zum Zitat Spannagl M, Bauersachs R, Debus ES, Gawaz M, Gerlach H, Haas S, Hach-Wunderle V, Lindhoff-Last E, Riess H, Schellong S, Schinzel H, Bode C (2012) Dabigatran therapy – perioperative management and interpretation of coagulation tests. Hamostaseologie 32(4):294–305CrossRefPubMed Spannagl M, Bauersachs R, Debus ES, Gawaz M, Gerlach H, Haas S, Hach-Wunderle V, Lindhoff-Last E, Riess H, Schellong S, Schinzel H, Bode C (2012) Dabigatran therapy – perioperative management and interpretation of coagulation tests. Hamostaseologie 32(4):294–305CrossRefPubMed
35.
Zurück zum Zitat Koscielny J, Rutkauskaite E (2015) Blutungen unter NOAK: Evidenz und praktisches Vorgehen (Bleedings under NOAC (non Vitamin-K dependent oral anticoagulants): Evidence and practical management). Hamostaseologie 35(Suppl 1):S43–S53PubMed Koscielny J, Rutkauskaite E (2015) Blutungen unter NOAK: Evidenz und praktisches Vorgehen (Bleedings under NOAC (non Vitamin-K dependent oral anticoagulants): Evidence and practical management). Hamostaseologie 35(Suppl 1):S43–S53PubMed
36.
Zurück zum Zitat Maegele M, Grottke O, Schöchl H, Sakowitz OA, Spannagl M, Koscielny J (2016) Direct oral anticoagulants in emergency trauma admissions. Dtsch Arztebl Int 113(35–36):575–582PubMed Maegele M, Grottke O, Schöchl H, Sakowitz OA, Spannagl M, Koscielny J (2016) Direct oral anticoagulants in emergency trauma admissions. Dtsch Arztebl Int 113(35–36):575–582PubMed
37.
Zurück zum Zitat Faraoni D, Levy J, Albaladejo P, Samama C (2015) Groupe d’Interet en hemostase perioperative. Updates in the perioperative and emergency management of non-vitamin K antagonist oral antocoagulants. Crit Care 19(1):203CrossRefPubMedPubMedCentral Faraoni D, Levy J, Albaladejo P, Samama C (2015) Groupe d’Interet en hemostase perioperative. Updates in the perioperative and emergency management of non-vitamin K antagonist oral antocoagulants. Crit Care 19(1):203CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Giebl A, Gürtler KK (2014) Neue orale Antikoagulanzien in der perioperativen Medizin. Anaesthesist 63:347–364CrossRefPubMed Giebl A, Gürtler KK (2014) Neue orale Antikoagulanzien in der perioperativen Medizin. Anaesthesist 63:347–364CrossRefPubMed
39.
Zurück zum Zitat Koscielny J, Beyer-Westendorf J, von Heymann C et al (2012) Risk of bleeding and haemorrhagic complication with rivaroxaban – periprocedural management of haemostasis. Hamostaseologie 32:287–293CrossRefPubMed Koscielny J, Beyer-Westendorf J, von Heymann C et al (2012) Risk of bleeding and haemorrhagic complication with rivaroxaban – periprocedural management of haemostasis. Hamostaseologie 32:287–293CrossRefPubMed
40.
Zurück zum Zitat Pollack C, Reilley P, Eikelboom J et al (2015) Idarucizumab for dabigatran reversal. N Engl J Med 373:511–520CrossRefPubMed Pollack C, Reilley P, Eikelboom J et al (2015) Idarucizumab for dabigatran reversal. N Engl J Med 373:511–520CrossRefPubMed
41.
Zurück zum Zitat Spannagl M, Koscielny J, Kiesewetter H (2009) Aktuelle Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten der Bundesärztekammer, Kapitel 7: Prokoagulatoren, 4. Aufl., S 153–154 Spannagl M, Koscielny J, Kiesewetter H (2009) Aktuelle Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten der Bundesärztekammer, Kapitel 7: Prokoagulatoren, 4. Aufl., S 153–154
42.
Zurück zum Zitat Guyatt GH, Akl EA, Crowther M, Gutterman DD, American College of Chest (2012) Executive summary : antithrombotic therapy and prevention of thrombosis. Chest 141:7–47CrossRef Guyatt GH, Akl EA, Crowther M, Gutterman DD, American College of Chest (2012) Executive summary : antithrombotic therapy and prevention of thrombosis. Chest 141:7–47CrossRef
43.
Zurück zum Zitat Marlu R, Hodaj E, Paris A, Albaladejo P, Crackowski JL, Pernod G (2012) Effect of non-specific reversal agents on anticoagulant activity of dabigatran and rivaroxaban. A randomised crossover ex vivo study in healthy volunteers. Thromb Haemost 108(2):8–12CrossRef Marlu R, Hodaj E, Paris A, Albaladejo P, Crackowski JL, Pernod G (2012) Effect of non-specific reversal agents on anticoagulant activity of dabigatran and rivaroxaban. A randomised crossover ex vivo study in healthy volunteers. Thromb Haemost 108(2):8–12CrossRef
44.
Zurück zum Zitat Kaatz S, Crowther M (2013) Reversal of target-specific oral anticoagulants. J Thromb Thrombolysis 36:195–202CrossRefPubMed Kaatz S, Crowther M (2013) Reversal of target-specific oral anticoagulants. J Thromb Thrombolysis 36:195–202CrossRefPubMed
45.
Zurück zum Zitat Dager W, Roberts A (2013) Reversing dabigatran in a life-threatening bleed occurring during cardiac ablation with factor eight inhibitor bypassing activity. Crit Care Med 41:42–46CrossRef Dager W, Roberts A (2013) Reversing dabigatran in a life-threatening bleed occurring during cardiac ablation with factor eight inhibitor bypassing activity. Crit Care Med 41:42–46CrossRef
46.
Zurück zum Zitat Dager W, Roberts A (2011) Reversing dabigatran with Feiba in a patient with a transseptal perforation during cardiac ablation. Crit Care Med 39(Suppl 12):243–244 Dager W, Roberts A (2011) Reversing dabigatran with Feiba in a patient with a transseptal perforation during cardiac ablation. Crit Care Med 39(Suppl 12):243–244
47.
Zurück zum Zitat Elg M, Carlsson S, Gustafsson S (2001) Effect of activated prothrombin complex concentrate or recombinant factor VIIa on the bleeding time and thrombus formation during anticoagulation with a direct thrombin inhibitor. Thromb Res 101:145–157CrossRefPubMed Elg M, Carlsson S, Gustafsson S (2001) Effect of activated prothrombin complex concentrate or recombinant factor VIIa on the bleeding time and thrombus formation during anticoagulation with a direct thrombin inhibitor. Thromb Res 101:145–157CrossRefPubMed
48.
Zurück zum Zitat Warkentin TE, Margetts P, Connolly SJ, Lamy A, Ricci C, Eikelboom JW (2012) Recombinant factor VIIa (rFVIIa) and hemodialysis to manage massive dabigatran-associated postcardiac surgery bleeding. Blood 119(9):2172–2174CrossRefPubMed Warkentin TE, Margetts P, Connolly SJ, Lamy A, Ricci C, Eikelboom JW (2012) Recombinant factor VIIa (rFVIIa) and hemodialysis to manage massive dabigatran-associated postcardiac surgery bleeding. Blood 119(9):2172–2174CrossRefPubMed
50.
Zurück zum Zitat Diaz MQ, Borobia AM, Nunez MA, Virto AM, Fabra S, Casado MS, Garcia-Erce JA, Samama CM (2013) Use of prothrombin complex concentrates for urgent reversal of dabigatran in the emergency depertment. Haematologica 98(11):e143–e144CrossRefPubMedPubMedCentral Diaz MQ, Borobia AM, Nunez MA, Virto AM, Fabra S, Casado MS, Garcia-Erce JA, Samama CM (2013) Use of prothrombin complex concentrates for urgent reversal of dabigatran in the emergency depertment. Haematologica 98(11):e143–e144CrossRefPubMedPubMedCentral
51.
Zurück zum Zitat Majeed A, Schulman S (2013) Bleeding and antidotes in new oral anticoagulants. Best Pract Res Clin Haematol 26(2):191–202CrossRefPubMed Majeed A, Schulman S (2013) Bleeding and antidotes in new oral anticoagulants. Best Pract Res Clin Haematol 26(2):191–202CrossRefPubMed
52.
Zurück zum Zitat Siegal DM, Garcia DA, Crowther MA (2014) How I treat target-specific oral anticoagulant-associatd bleeding. Blood 123(8):1152–1158CrossRefPubMed Siegal DM, Garcia DA, Crowther MA (2014) How I treat target-specific oral anticoagulant-associatd bleeding. Blood 123(8):1152–1158CrossRefPubMed
53.
Zurück zum Zitat Levi M, Erenberg E, Kamphuisen PW (2011) Bleeding risk and reversal strategies for old and new anticoagulants and antiplatelet agents. J Thromb Haemost 9:1705–1712CrossRefPubMed Levi M, Erenberg E, Kamphuisen PW (2011) Bleeding risk and reversal strategies for old and new anticoagulants and antiplatelet agents. J Thromb Haemost 9:1705–1712CrossRefPubMed
54.
Zurück zum Zitat Grottke O, van Ryn J, Spronk H, Rossaint R (2014) Prothrombin complex concentrates and a specific antidote to dabigatran are effective ex-vivo in reversing the effects of dabigatran in an anticoagulation/liver trauma experimental model. Crit Care 18:R27CrossRefPubMedPubMedCentral Grottke O, van Ryn J, Spronk H, Rossaint R (2014) Prothrombin complex concentrates and a specific antidote to dabigatran are effective ex-vivo in reversing the effects of dabigatran in an anticoagulation/liver trauma experimental model. Crit Care 18:R27CrossRefPubMedPubMedCentral
55.
Zurück zum Zitat Honickel M, Treutler S, van Ryn J, Tillmann S, Rossaint R, Grottke O (2015) Reversal of dabigatran anticoagulation ex vivo: Porcine study comparing prothrombin complex concentrates and idaricizumab. Thromb Haemost 113:728–740CrossRefPubMed Honickel M, Treutler S, van Ryn J, Tillmann S, Rossaint R, Grottke O (2015) Reversal of dabigatran anticoagulation ex vivo: Porcine study comparing prothrombin complex concentrates and idaricizumab. Thromb Haemost 113:728–740CrossRefPubMed
56.
Zurück zum Zitat Honickel M, Maron B, van Ryn J, Braunschweig T, ten Cate H, Spronk H, Roissaint R, Grottke O (2016) Therapy with activated prothrombin complex concentrate is effective in reducing dabigatran-associated blood loss in a porcine polytrauma model. Thromb Haemost 115(2):271–284CrossRefPubMed Honickel M, Maron B, van Ryn J, Braunschweig T, ten Cate H, Spronk H, Roissaint R, Grottke O (2016) Therapy with activated prothrombin complex concentrate is effective in reducing dabigatran-associated blood loss in a porcine polytrauma model. Thromb Haemost 115(2):271–284CrossRefPubMed
57.
Zurück zum Zitat Honickel M, Braunschweig T, van Ryn J, ten Cate H, Spronk H, Rossaint R, Grottke O (2015) Prothrombin complex concentrate is effective in treating the antocoagulant affects of dabigatran in a porcine polytrauma model. Anaesthesiology 123(6):1350–1361CrossRef Honickel M, Braunschweig T, van Ryn J, ten Cate H, Spronk H, Rossaint R, Grottke O (2015) Prothrombin complex concentrate is effective in treating the antocoagulant affects of dabigatran in a porcine polytrauma model. Anaesthesiology 123(6):1350–1361CrossRef
58.
Zurück zum Zitat Beyer-Westendorf J, Förster K, Pannach S, Ebertz F, Gelbricht V, Thieme C, Michalski F, Köhler C, Werth S, Sahin K, Tittl L, Hänsel U, Weiss N (2014) Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAK registry. Blood 124(6):955–962CrossRefPubMedPubMedCentral Beyer-Westendorf J, Förster K, Pannach S, Ebertz F, Gelbricht V, Thieme C, Michalski F, Köhler C, Werth S, Sahin K, Tittl L, Hänsel U, Weiss N (2014) Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAK registry. Blood 124(6):955–962CrossRefPubMedPubMedCentral
59.
Zurück zum Zitat Escolar G, Fernandez-Gallego V, Arellano-Rodrigo E, Roquer J, Reverter JC, Sanz VV et al (2013) Reversal of apixaban induced alterations in haemostasis by different coagulation factor concentrates: Significance of studies in vitro with circulationg human blood. PLOS ONE 8:e78696CrossRefPubMedPubMedCentral Escolar G, Fernandez-Gallego V, Arellano-Rodrigo E, Roquer J, Reverter JC, Sanz VV et al (2013) Reversal of apixaban induced alterations in haemostasis by different coagulation factor concentrates: Significance of studies in vitro with circulationg human blood. PLOS ONE 8:e78696CrossRefPubMedPubMedCentral
60.
Zurück zum Zitat Siegal D, Curnutte J, Connolly S, Lu G, Conoley P, Wiens B, Mathur V, Castillo J, Bronson M, Leeds J, Mar F, Gold A, Crowther M (2015) Andexanet alpha for the reversal of factor Xa inhibitor activity. N Engl J Med 373(25):2413–2424CrossRefPubMed Siegal D, Curnutte J, Connolly S, Lu G, Conoley P, Wiens B, Mathur V, Castillo J, Bronson M, Leeds J, Mar F, Gold A, Crowther M (2015) Andexanet alpha for the reversal of factor Xa inhibitor activity. N Engl J Med 373(25):2413–2424CrossRefPubMed
61.
Zurück zum Zitat Crowther M, Crowther MA (2015) Antidotes for novel oral anticoagulants: current status and future potential. Arterioscler Thromb Vasc Biol 35(8):1736–1745CrossRefPubMed Crowther M, Crowther MA (2015) Antidotes for novel oral anticoagulants: current status and future potential. Arterioscler Thromb Vasc Biol 35(8):1736–1745CrossRefPubMed
62.
Zurück zum Zitat Liotta EM, Levasseur-Franklin KE, Naidech AM (2015) Reversal of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban. Curr Opin Crit Care 21(2):127–133CrossRefPubMed Liotta EM, Levasseur-Franklin KE, Naidech AM (2015) Reversal of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban. Curr Opin Crit Care 21(2):127–133CrossRefPubMed
63.
Zurück zum Zitat Husted S, Verheugt FW, Comuth WJ (2016) Reversal strategies for NOACs: State of development, possible clinical applications and future persepectives. Drug Saf 39(1):5–13CrossRefPubMed Husted S, Verheugt FW, Comuth WJ (2016) Reversal strategies for NOACs: State of development, possible clinical applications and future persepectives. Drug Saf 39(1):5–13CrossRefPubMed
64.
Zurück zum Zitat Gomez-Outes A, Suarez-Gea M, Lecumberri R, Terleira-fernandez A, Vargas-Castrillon E (2014) Specific antidotes in development for reversal of novel anticoagulants. Recent Pat Cardiovasc Drug Discov 9(1):2–10CrossRefPubMed Gomez-Outes A, Suarez-Gea M, Lecumberri R, Terleira-fernandez A, Vargas-Castrillon E (2014) Specific antidotes in development for reversal of novel anticoagulants. Recent Pat Cardiovasc Drug Discov 9(1):2–10CrossRefPubMed
65.
Zurück zum Zitat Connolly S et al (2016) Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med 375:1131–1141CrossRefPubMed Connolly S et al (2016) Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med 375:1131–1141CrossRefPubMed
66.
Zurück zum Zitat Getta B, Muller N, Motum P, Hsu D, Zebeljan D, Rosenfeld D (2015) Intermittend haemodialysis and continous veno-venous dialysis are effective in mitigating major bleeding due to dabigatran. Br J Haematol 169:603–604CrossRefPubMed Getta B, Muller N, Motum P, Hsu D, Zebeljan D, Rosenfeld D (2015) Intermittend haemodialysis and continous veno-venous dialysis are effective in mitigating major bleeding due to dabigatran. Br J Haematol 169:603–604CrossRefPubMed
67.
Zurück zum Zitat Wang X, Mondal S, Wang J, Tirucherai G, Zhang D, Boyd RA, Frost C (2014) Effect of activated charcoal on apixaban pharmacokinetics in healthy subjects. Am J Cardiovasc Drugs 14(2):147–154CrossRefPubMed Wang X, Mondal S, Wang J, Tirucherai G, Zhang D, Boyd RA, Frost C (2014) Effect of activated charcoal on apixaban pharmacokinetics in healthy subjects. Am J Cardiovasc Drugs 14(2):147–154CrossRefPubMed
68.
Zurück zum Zitat Hart RG, Diener HC, Yang S et al (2012) Intraccranial hemorrhage in atrial fibrillation patients during anticoagulation with warfarin or dabigatran: the Re-Ly trial. Stroke 43(6):1511–1517CrossRefPubMed Hart RG, Diener HC, Yang S et al (2012) Intraccranial hemorrhage in atrial fibrillation patients during anticoagulation with warfarin or dabigatran: the Re-Ly trial. Stroke 43(6):1511–1517CrossRefPubMed
69.
Zurück zum Zitat Purrucker JC, Haas K, Rizos T, Khan S, Wolf M, Hennerici MG, Poli S, Kleinschnitz C, Steiner T, Heuschmann PU, Veltkamp R (2016) Early clinical and radiological course, management, and outcome of cerebral hemorrhage related to new oral anticoagulants. JAMA Neurol 73(2):169–177CrossRefPubMed Purrucker JC, Haas K, Rizos T, Khan S, Wolf M, Hennerici MG, Poli S, Kleinschnitz C, Steiner T, Heuschmann PU, Veltkamp R (2016) Early clinical and radiological course, management, and outcome of cerebral hemorrhage related to new oral anticoagulants. JAMA Neurol 73(2):169–177CrossRefPubMed
70.
Zurück zum Zitat Flibotte JJ, Hagan N, O’Donell J, Greenberg SM, Rosand J (2004) Warfarin, hemotoma expansion, and outcome of intracerebral hemorrhage. Neurology 63:1059–1064CrossRefPubMed Flibotte JJ, Hagan N, O’Donell J, Greenberg SM, Rosand J (2004) Warfarin, hemotoma expansion, and outcome of intracerebral hemorrhage. Neurology 63:1059–1064CrossRefPubMed
71.
72.
Zurück zum Zitat Kuramatsu JB, Gerner ST, Schellinger PD, Glahn J, Endres M et al (2015) Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 313(8):824–836CrossRefPubMed Kuramatsu JB, Gerner ST, Schellinger PD, Glahn J, Endres M et al (2015) Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 313(8):824–836CrossRefPubMed
73.
Zurück zum Zitat Koscielny J, Rutkauskaite E (2015) Bleedings under NOAC (non Vitamin-K dependent oral anticoagulants). Evidence and practical management. Hamostaseologie 35(Suppl 1):S43–S53PubMed Koscielny J, Rutkauskaite E (2015) Bleedings under NOAC (non Vitamin-K dependent oral anticoagulants). Evidence and practical management. Hamostaseologie 35(Suppl 1):S43–S53PubMed
74.
Zurück zum Zitat Sie P, Samama CM, Godier A, Rosenacher N, Steib A, Llau JV et al (2011) Sugery and invasive procedures in patients on long-term treatment with direct oral anticoagulants: thrombin or factor-Xa inhibitors. Recommendations of the Working Group on Perioperative Haemostasis and the French Study Group on Thrombosis and Heamostasis. Arch Cardiovasc Dis 104:669–676CrossRefPubMed Sie P, Samama CM, Godier A, Rosenacher N, Steib A, Llau JV et al (2011) Sugery and invasive procedures in patients on long-term treatment with direct oral anticoagulants: thrombin or factor-Xa inhibitors. Recommendations of the Working Group on Perioperative Haemostasis and the French Study Group on Thrombosis and Heamostasis. Arch Cardiovasc Dis 104:669–676CrossRefPubMed
75.
Zurück zum Zitat Lai A, Davidson N, Galloway SW, Thachil J (2014) Perioperative management of patients on new oral anticoagulants. Br J Surg 101:742–749CrossRefPubMed Lai A, Davidson N, Galloway SW, Thachil J (2014) Perioperative management of patients on new oral anticoagulants. Br J Surg 101:742–749CrossRefPubMed
76.
Zurück zum Zitat Perzborn E, Heitmeier S, Laux V, Buchmueller A (2014) Reversal of rivaroxaban-induced anticoagulation with prothrombin complex concentrate, activated prothrombin complex concentrate and recombinant activated factor VIIa in vitro. Thromb Res 133(4):671–681CrossRefPubMed Perzborn E, Heitmeier S, Laux V, Buchmueller A (2014) Reversal of rivaroxaban-induced anticoagulation with prothrombin complex concentrate, activated prothrombin complex concentrate and recombinant activated factor VIIa in vitro. Thromb Res 133(4):671–681CrossRefPubMed
77.
Zurück zum Zitat Zhou W, Schwarting S, Illanes S, Liesz A, Midelhoff M, Zorn M, Bendszus M, Heiland S, van Ryn J, Veltkamp R (2011) Hemostatic therapy in experimental intracerebral hemorrhage associated with the direct thrombin inhibitor dabigatran. Stroke 42(12):3594–3599CrossRefPubMed Zhou W, Schwarting S, Illanes S, Liesz A, Midelhoff M, Zorn M, Bendszus M, Heiland S, van Ryn J, Veltkamp R (2011) Hemostatic therapy in experimental intracerebral hemorrhage associated with the direct thrombin inhibitor dabigatran. Stroke 42(12):3594–3599CrossRefPubMed
Metadaten
Titel
Nicht-Vitamin-K-abhängige orale Antikoagulanzien
Notfallmanagement bei Patienten mit Blutungen unter oraler Antikoagulation
verfasst von
Priv.-Doz. Dr. med. J. Koscielny
Dr. C. Rosenthal
Prof. Dr. C. von Heymann
Publikationsdatum
12.04.2017
Verlag
Springer Medizin
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 3/2017
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-017-0289-3

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