Der Anaesthesist

, Volume 59, Issue 1, pp 62–68 | Cite as

Alte und neue Gerinnungshemmer

Antidota und Maßnahmen bei akuter Blutung sowie dringenden Eingriffen
Klinische Pharmakologie
First Online:

Zusammenfassung

Gerinnungshemmende Medikamente werden häufig zur primären sowie sekundären Prävention und zur Therapie bei diversen thrombembolischen Krankheitsbildern eingesetzt. Eine wesentliche Nebenwirkung aller Gerinnungshemmer ist die hämorrhagische Diathese. Diese erfordert eine akute Behandlung. Idealerweise ist hier die medikamentöse Therapie mit einem Antidot möglich. Mit traditionellen Gerinnungshemmern wie z. B. Heparin und Vitamin-K-Antagonisten liegen ausreichende Erfahrungen vor. Für beide existieren anerkannte Behandlungsstrategien; hierbei kommen u. a. auch Antagonisten zum Einsatz. Aktuell steht eine Vielzahl faktorenspezifischer Antikoagulanzien kurz vor der Zulassung oder ist in der jüngeren Vergangenheit auf den Markt gekommen. Für diese Antikoagulanzien der neuen Generation gibt es zurzeit weder valide Laborparameter noch effektive Antagonisten. In Ermangelung ausreichender Studien kann eine Behandlung hier momentan lediglich symptomatisch erfolgen.

Schlüsselwörter

Akute Blutung Antikoagulation Drugmonitoring Klinische Behandlung 

Old and new anticoagulants

Antidotes and measures for acute hemorrhaging and urgent interventions

Abstract

Anticoagulation medications are frequently used for primary and secondary treatment of several thrombo-embolic disorders. An important side effect of all anticoagulants is hemorrhagic diathesis which necessitates acute treatment, ideally using medicinal therapy with an antidote. Much experience has been gained in treating bleeding while on traditional anticoagulants, such as heparins and vitamin K antagonists by the use of antagonists. A multitude of factor-specific anticoagulants have recently been introduced or will soon receive approval. With this new generation of anticoagulants no valid laboratory parameters or effective antagonists are presently available. Due to a lack of adequate studies regarding acute treatment this can at present only be carried out on a symptomatic basis.

Keywords

Acute hemorrhage Anticoagulation Drug monitoring Clinical treatment 
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Notes

Danksagung

Die Autoren danken Dr. J. Schreiber für das kritische Durchlesen des Beitrags und die hieraus folgende Diskussion.

Interessenkonflikt

Keine Angaben

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  • M. Lancé
    • 1
  • B. Stessel
    • 1
  • K. Hamulyák
    • 2
  • M.A. Marcus
    • 1
  1. 1.Klinik für Anästhesiologie und SchmerztherapieUniversitätsklinikum MUMC+AZ MaastrichtNiederlande
  2. 2. Abteilung Hämatologie und Laboratorium, Medizinische KlinikUniversitätsklinikum MUMC+MaastrichtNiederlande

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