Der Internist

, Volume 51, Issue 11, pp 1446–1455

Antikoagulation im Alter

  • J. Harenberg
  • R. Bauersachs
  • C. Diehm
  • H. Lawall
  • H. Burkhardt
  • H. Gerlach
  • H. Darius
  • H. Völler
  • E. Rabe
  • M. Wehling
Arzneimitteltherapie

Zusammenfassung

Die Empfehlungen für die Antikoagulation bei über 80-jährigen Patienten orientieren sich an der Abwägung des Thromboembolie- und des Blutungsrisikos. Sie ergänzen die bisher vorliegenden Empfehlungen für die betroffenen Indikationen. Die postoperative Thromboembolieprophylaxe erfolgt bei dieser Patientengruppe mit niedermolekularem Heparin (NMH). Bei sehr hohem Blutungsrisiko werden angepasste Kompressionsstrümpfe oder die intermittierende pneumatische Kompression eingesetzt. Bei sehr hohem Thromboembolierisiko wird ab dem 2. postoperativen Tag die Dosis gesteigert. Blutungs- und Thromboembolierisiko sind täglich neu festzulegen und die Therapie entsprechend anzupassen. Bei akuten Erkrankungen mit Bettlägerigkeit erfolgt die Thromboembolieprophylaxe wie postoperativ. Die Therapie der venösen Thromboembolie soll mit zwei Drittel der therapeutischen Dosis erfolgen. Eine eingeschränkte Nierenfunktion (Kreatinin-Clearance <30 ml/min für die meisten NMH und <20 ml/min für Tinzaparin) soll zu einer stärkeren Dosisreduktion führen. Intensität und Dauer der Rezidivprophylaxe mit Vitamin-K-Antagonisten, oder bei gleichzeitig bestehenden Malignomen mit NMH, erfolgen nach den bestehenden oder hier beschriebenen Empfehlungen. Die Antikoagulation bei Vorhofflimmern erfolgt mit Vitamin-K-Antagonisten und einer INR von 2–3. In besonderen klinischen Situationen wird die Antikoagulation nach den nationalen oder internationalen Empfehlungen durchgeführt.

Schlüsselwörter

Antikoagulation Vitamin-K-Antagonisten Niedermolekulares Heparin Niereninsuffizienz Alter 

Anticoagulation in the elderly

Abstract

The recommendations for anticoagulation in over 80 years old patients are based on the thromboembolic/bleeding risk relation. They add to the published recommendations for the specific indications. Low-molecular-weight heparin (LMWH) is used to prevent thromboembolism postoperatively. Compression stockings and/or intermittent pneumatic compression are used if bleeding risk is very high. The dose is increased starting at day two if the thromboembolic risk is very high. Bleeding and thromboembolic risks are re-evaluted daily. The antithrombotic therapy is adjusted accordingly. Prophylaxis of thromboembolism in patients with acute illnesses and bedrest is performed according postoperative care. Two-thirds of therapeutic doses of low-molecular-weight heparin are used to treat acute venous thromboembolism. Reduced renal function (creatinine clearance <30 ml/ min for most LMWHs or <20 ml/min for tinzaparin) should result in a further reduction of dose. Intensity and duration of prophylaxis of recurrent events with vitamin K antagonist or LMWH in malignancy follow current or herein described recommendations. Patients with atrial fibrillation are treated with vitamin K antagonists adjusted to an INR of 2–3 for prophylaxis of embolism. Further details of anticoagulant therapy should be in agreement with the national or international recommendations.

Keywords

Anticoagulation Vitamin K antagonists Low molecular weight heparin Renal impairment Elderly 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • J. Harenberg
    • 1
  • R. Bauersachs
    • 2
  • C. Diehm
    • 3
  • H. Lawall
    • 3
  • H. Burkhardt
    • 4
  • H. Gerlach
    • 5
  • H. Darius
    • 6
  • H. Völler
    • 7
  • E. Rabe
    • 8
  • M. Wehling
    • 1
  1. 1.Klinische Pharmakologie MannheimRuprecht-Karls-Universität HeidelbergMannheimDeutschland
  2. 2.Medizinische Klinik IV, Max-Ratschow-Klinik für AngiologieKlinikum DarmstadtDarmstadtDeutschland
  3. 3.SRH KlinikumKarlsbad-LangensteinbachDeutschland
  4. 4.IV. Medizinische KlinikUniversitätsmedizinMannheimDeutschland
  5. 5.Praxis für GefäßerkrankungenMannheimDeutschland
  6. 6.VivantesBerlinDeutschland
  7. 7.Klinik am SeeRüdersdorfDeutschland
  8. 8.Medizinische UniversitätsklinikBonnDeutschland

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