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Neue orale Antikoagulanzien

Werden sie die Vitamin-K-Antagonisten verdrängen?

New oral anticoagulants

Better than vitamin K antagonists?

  • Arzneimitteltherapie
  • Published:
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Zusammenfassung

Langjährige praktische Erfahrung unter Einbeziehung des Patienten, gepaart mit intensiver wissenschaftlicher Begleitung, haben die Vitamin-K-Antagonisten zu einem Eckpfeiler der dauerhaften Prophylaxe und Therapie internistischer Erkrankungen werden lassen. Bekannte Limitationen in der Pharmakokinetik und -dynamik, umständlich erscheinende Therapiekontrolle auf der einen sowie die bevorstehende Verfügbarkeit innovativer Produkte mit gezielter Antikoagulationshemmung ohne Kontrollbedarf auf der anderen Seite fordern eine aktuelle Bestandsaufnahme. Für die perioperative Endoprothetik konnte für den direkten Thrombininhibitor Dabigatranetexilat sowie die Faktor-Xa-Inhibitoren Rivaroxaban und Apixaban inzwischen der Effektivitätsnachweis im Vergleich zu niedermolekularen Heparinen erbracht werden; zur kurzfristigen Thromboseprophylaxe bei internistischen Erkrankungen wird ihre Wirksamkeit zurzeit untersucht. Für die langfristige Gabe (6 bzw. 24 Monate) zur Therapie tiefer Beinvenenthrombosen bzw. zur Schlaganfallprophylaxe bei Vorhofflimmern existieren bereits Daten für den direkten Thrombininhibitor Dabigatranetexilat, dessen Effektivität im Vergleich zu Vitamin-K-Antagonisten bei ähnlichem Sicherheitsprofil in Abhängigkeit der Dosierung gleich oder überlegen ist. Allerdings werden die langjährig erprobten Vitamin-K-Antagonisten weiterhin so lange die Basis der oralen Antikoagulationstherapie darstellen, bis offene Fragen z. B. bezüglich unzureichender Therapieadhärenz (Abbruchrate bis 20%) oder existierender Arzneimittelinteraktionen der neuen Konkurrenzprodukte beantwortet sind.

Abstract

Many years of practical use and intensive scientific research have allowed vitamin K antagonists to become a cornerstone of treatment of internal diseases. Nevertheless, limitations in pharmacokinetics and -dynamics of vitamin K antagonists and the availability of new drugs in regard to a targeted anticoagulation therapy ask for a new review of the situation. Proof of effectiveness for the perioperative prophylaxis of venous thrombosis after hip and knee replacement has already been achieved for the direct thrombin inhibitor dabigatran etexilate as well as for the factor Xa inhibitors rivaroxaban und apixaban compared to low molecular weight heparins. These new drugs are now also investigated in patients with internal diseases. For the long-term application (6 or 12 months) concerning the treatment of venous thrombosis and/or stroke prophylaxis in patients with atrial fibrillation data is already available for the direct thrombin inhibitor dabigatran etexilate. Depending on its dosage its effectiveness in comparison with vitamin K antagonists is equal or even better without disadvantages in safety. However, vitamin K antagonists will remain the standard oral anticoagulation until open questions regarding e.g. insufficient therapy adherence (with termination rates up to 20%) or problems with drug interactions of the new competitive products have been completely answered.

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Interessenkonflikt

Prof. Dr. H. Völler erhielt Vortragshonorare der Firmen Pfizer Pharma GmbH und Boehringer Ingelheim Pharma GmbH & Co. Prof. Dr. S. Alban ist als Referentin für die Firma Bayer Vital GmbH tätig und erhielt im Jahr 2007 Beratungshonorar von der Firma Boehringer Ingelheim. Dr. D. Westermann gibt an, keinen Interessenkonflikt zu haben.

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Authors and Affiliations

  1. FESC, Klinik am See, Rehabilitationszentrum für Innere Medizin, Seebad 84, 15562, Rüdersdorf, Deutschland

    H. Völler

  2. Pharmazeutisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland

    S. Alban

  3. Centrum für Herz-, Kreislauf- und Gefäßmedizin, Medizinische Klinik II – Kardiologie und Pulmologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    D. Westermann

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  1. H. Völler
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Correspondence to H. Völler.

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Völler, H., Alban, S. & Westermann, D. Neue orale Antikoagulanzien. Internist 51, 1571–1581 (2010). https://doi.org/10.1007/s00108-010-2725-z

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